Remote Clinical Review Pharmacist Utilization & PA Expert
Actalent
Actalent is hiring a Clinical Review Pharmacist for a 100% remote position, focusing on reviewing Utilization Management requests. Ideal candidates should have a PharmD, experience in a retail environment, and be able to communicate effectively. Responsibilities include evaluating coverage requests, consulting with healthcare providers, and ensuring accurate and consistent clinical decisions across teams. Benefits include medical, dental, and vision coverage, along with a 401(k) plan. This is a full-time, contract role based in Las Vegas, NV. #J-18808-Ljbffr
- ...Actalent is seeking a Clinical Review Pharmacist for a fully remote contract position based in Salt Lake City, UT. Candidates will evaluate Utilization Management requests, consulting with healthcare providers and ensuring adherence to formularies. Required qualifications...Remote workContract work
$223.8k - $313.1k
...company is seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes collaboration and structured... .... Join a dedicated team focused on effective utilization management while enjoying a competitive compensation...Remote work$113.7k - $162.4k
JobRx, Inc. seeks a Clinical Pharmacist to support pharmacy solutions programs, including prior authorization... ...initiatives. You will evaluate drug reviews based on evidence-based research and... ..., and knowledge of Medicaid. This is a remote position within the U.S., with a salary...Remote work- ...A major healthcare organization is seeking a registered nurse for a remote position focused on utilization review. Candidates should have 2 years of experience in a hospital setting and expertise in evaluating medical necessity. Responsibilities include assessing care...Remote work
$49.34 - $76.59 per hour
...A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse License and have at least 5 years of clinical nursing experience, particularly in collaboration with physicians. This...Remote work- ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
- ...Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification... .... You will be responsible for reviewing home health clinical documentation, auditing OASIS documentation, and...Remote workFlexible hoursWeekend workWeekday work
- ...A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating... ...of experience in utilization review and significant clinical experience in an acute setting. Strong written and...Remote work
$35 - $45.94 per hour
...Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves performing medical necessity reviews and working... ...experience in utilization review or acute care settings. This remote position offers a competitive pay range of $35.00 to $45.94...Remote workHourly pay$65k - $75k
Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing... ..., 5+ years of clinical experience, and 2+ years in utilization review or claims auditing. This full-time position...Remote workFull time- ...Santa Barbara Cottage Hospital is hiring a Utilization Review Nurse for a remote position. The role involves gathering clinical information, certifying medical necessity, and making decisions on treatment certifications. Ideal candidates will have a strong nursing background...Remote work
- ...Social Services position in Albemarle, NC. This role involves reviewing service plans and authorization requests to ensure individuals... ...A competitive compensation package including benefits and flexibility is offered, with a remote option available. #J-18808-Ljbffr...Remote workFull time
- ...A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
$55 per hour
...Fully Remote Clinical Review Pharmacist Well-Known PBM | Offers Benefits | Fully Remote | Pay: $55/... ...responsible for reviewing Medicaid members' Utilization Management requests, including... ...initiatives through access to specialized experts who drive scale, innovation and...Remote workPermanent employmentContract workTemporary workWork from homeMonday to FridayRotating shiftWeekend work$55 per hour
...Fully Remote Clinical Review Pharmacist Well-Known PBM | Offers Benefits | Fully Remote | Pay: $55/hr.... ...responsible for reviewing Medicaid members' Utilization Management requests, including... ...through access to specialized experts who drive scale, innovation and speed...Remote workPermanent employmentContract workTemporary workWork from homeMonday to FridayRotating shiftWeekend work$55 per hour
...Remote Clinical Pharmacist – Medicare UMJob Summary We are seeking a Remote Clinical Pharmacist to review Medicare utilization management requests, including prior authorizations, formulary exceptions... ...through access to specialized experts who drive scale, innovation and...Remote workFull timeContract workTemporary workLive inWork from home$104k - $143k
...part of our caring community The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist... ...and comprehensive medication reviews for prescriptions requiring pre-authorization... ...season Travel: While this is a remote position, occasional travel to...Remote workDaily paidFull timeContract workApprenticeshipMonday to FridayFlexible hoursShift workWeekend work$91.7k - $163.7k
...Clinical Pharmacist Optum is a global organization that delivers care,... ...outcomes through completion of utilization management functions for... ...enjoy the flexibility to work remotely * from anywhere within the... ...prior authorization case reviews to meet production and performance...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday$89.9k - $160.6k
...Overview Join to apply for the Clinical Pharmacist Utilization Management - Remote PST role at Optum . Optum is a global organization that delivers... ...Completes assigned daily prior authorization case reviews to meet production and performance metrics as determined...Remote workMinimum wageFull timeWork experience placementLocal areaMonday to Friday$67.7k
...consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor... ...degree in nursing, and at least five years of clinical experience. Ideal candidates will work full-...Remote workFull timeMonday to Friday- ...Carolina is looking for a qualified applicant to perform medical reviews and support medical claims processing. The role involves... ...complex claims and documenting decisions based on established clinical guidelines. Applicants must hold an active RN license and have...Remote workFull time
$140.75k - $164.94k
...the business. The Manager, Clinical Services PA Pharmacists is a hands-on people... ...maintains an active clinical review workload while serving as... ...prior authorization, PBM, or utilization management experience preferred... ...change. We’re a nimble, remote-first team with a bold...Remote workFull timeWork at officeHome office- ...Technician to support retail pharmacy operations remotely. This role involves processing prescriptions, performing prior authorization reviews, and coordinating care for patients.... ...pharmacy, ideally with experience in utilization review. A strong knowledge of insurance processes...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...is seeking a Tennessee-licensed Clinical Pharmacist. In this role, you will provide expert medication therapy consultations... ...patient data, conducting medication reviews, and collaborating on software... .... The role is primarily remote but requires occasional on-site...Remote work
$57 - $65 per hour
...leading healthcare technology company seeks a Tennessee licensed Clinical Pharmacist to optimize patient outcomes through our software platform.... ...includes evaluating patient data, conducting medication reviews, and collaborating with clinical teams. Candidates must possess...Remote workHourly pay- ...dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role,... ...inpatient and outpatient utilization reviews, support transitions of care,... ...candidate will have strong clinical judgment, a valid RN license, and...Remote work
- ...SUBJECT MATTER EXPERT – UTILITY-SCALE SOLAR Engineering & Field Operations Consultant Location: Initially Remote-Houston, TX The Opportunity A global digital consulting... ...the solution team can design against. Review and validate proposed AI feature sets against...Remote workPermanent employmentContract workFor contractors
$90.87 - $154.33 per hour
...Prime Therapeutics is seeking a Physician Clinical Reviewer for Rheumatology to join their remote utilization management team. In this role, you will review service requests, collaborate with physicians, and ensure adherence to clinical guidelines. Candidates must have...Remote workHourly pay- ...Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential... ...analyzing medication use, applying clinical guidelines, and collaborating with providers... ...Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive...Remote work
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