Remote RN: Pharmacy Pre-Cert & Utilization Review

Quantum

Quantum Corporation is seeking a Pre-Cert Pharmacy Review Nurse, RN for their healthcare navigation team. The role involves reviewing specialty medications and collaborating with multidisciplinary teams to ensure quality care for members, either on-site in Dublin, OH, or remotely within the United States. The ideal candidate will possess a Bachelor’s degree in nursing and at least two years of nursing experience, ideally with a focus on managed care. Strong critical thinking and communication skills are essential for this role. #J-18808-Ljbffr

Apply

Vacancy posted 5 days ago

Similar jobs that could be interesting for youBased on the Remote RN: Pharmacy Pre-Cert & Utilization Review in New York, NY vacancy

Pre-Cert Pharmacy Review Nurse, RN (PBM- Pharmacy experience required)
...Pre-Certification Review Nurse - Pharmacy Founded in 1999 and headquartered in Central Ohio... ...determinations and utilization management reviews for specialty... ..., OH campus or may work remotely anywhere in the United... ...license as a Registered Nurse (RN) in the state of Ohio....
Remote work
Permanent employment
Casual work
Work at office
Quantum Health
United States
3 days ago
RN, Virtual Care
...A recruitment agency is seeking a Pre-Certification RN to evaluate clinical conditions and determine medical necessity for services. This remote position requires an active RN license in PA or a Compact license, along with a minimum of 3 years of acute care clinical experience...
Remote work
The Judge Group, LLC
New York, NY
2 days ago
Utilization Review Nurse/ Registered Nurse (RN) for LTSS Waiver/Medicaid - Remote in Virginia
...First (Days) Overview: Sentara Health Plansis hiring an Utilization Review Nurse/RN- Remote in Virginia Status: Full-time,permanent position (40... ...for services requiring authorization. Conducts pre-certification, continued stay review, care coordination,...
Remote work
Permanent employment
Full time
Temporary work
Shift work
Sentara Health
Norfolk, VA
5 hours ago
Registered Nurse-RN - Virtual Hospital
...by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review*... ...Commission/ Core Measure/National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*
Remote work
B2B Staffing Services
Torrance, CA
3 days ago
Remote Utilization Review Nurse RN - Part Time
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment... ...per week with responsibilities such as providing reviews for pre-certification requests, processing appeals, and working...
Remote work
Hourly pay
Part time
Santa Barbara Cottage Hospital
New York, NY
2 days ago
Urgent!! REMOTE Registered Nurse (RN)
$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift... ...-timers accepted: Yes Weekends Required: No Certs Required: BLS, WA RN License Will this traveler...
Remote work
Local area
Immediate start
Monday to Friday
Shift work
Weekend work
Pacer Group
Everett, WA
3 days ago
Registered Nurse (PRN) - Virtual Care
...multidisciplinary team in completing pre-screening assessments of... ...completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical... ...6-8 weeks. This role will be remote, including most training but monthly...
Remote work
Relief
3 days per week
IntelyCare
United States
3 days ago
Travel Nurse Pediatrics RN Day Shift Job
$2,109 per week
...Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Santa Rosa... ...smarter. **Exciting Opportunity for a Remote Utilization Review Registered Nurse!*... ...review - Continued stay reviews - Pre-certification and prior...
Remote work
Zero hours contract
Flexible hours
Shift work
Weekend work
Day shift
Catalytic Solutions, Inc.
Santa Rosa, CA
2 days ago
Utilization Review Nurse RN (Part-Time)
$30 - $38 per hour
...Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis,... ...for all outpatient and ancillary pre‑certification requests for medical... ...communication skills to successfully perform in a remote healthcare environment. Ability to...
Remote work
Hourly pay
Full time
Part time
Work at office
Monday to Friday
Weekend work
Santa Barbara Cottage Hospital
New York, NY
2 days ago
Utilization Management RN & Coding Specialist
$60.2k - $107.4k
...Utilization Management RN Coder Optum is a global organization that delivers care... ...people with the care, pharmacy benefits, data and resources... ...accurately and efficiently review and extract pertinent case details... ...of appeal tools including pre-constructed templates, and inclusion...
Remote work
Minimum wage
Full time
Work experience placement
Local area
UnitedHealthcare
Broomall, PA
16 days ago
Travel Utilization Review Nurse - $1,757 per week
$1,757 per week
...Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Santa Rosa... ...8-Hour (08:00 - 16:30) Description: Remote UR RN Modified Time:6/15/2026 12:00:... .../ Order DME*, OSHA*, Plan of Care*, Pre-Cert Review*, Pre-Cert Review*, Prior...
Remote work
16 hours
Permanent employment
Contract work
Temporary work
Zero hours contract
Local area
Shift work
Night shift
Weekend work
Prime Staffing
Santa Rosa, CA
4 days ago
Travel Nurse RN - Utilization Review - $35 to $45 per hour in Corpus Christi, TX
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...
Remote work
Hourly pay
Full time
Contract work
Immediate start
Shift work
3 days per week
Mindlance Health
Corpus Christi, TX
5 days ago
Travel Nurse RN - Utilization Review - $35 to $45 per hour in Corpus Christi, TX
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...
Remote work
Hourly pay
Full time
Contract work
Immediate start
Shift work
3 days per week
TravelNurseSource
Corpus Christi, TX
5 days ago
Remote Nurse Analyst
...providing telephonic and e-referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....
Remote work
Full time
Work from home
Shift work
Weekend work
Afternoon shift
MRINetwork
United States
2 days ago
Remote Utilization RN - Case Review & Care
...CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...
Remote work
Freelanceshop
New York, NY
10 hours ago
Nurse (Health Care)
...100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals... ...Registered Nurse with Utilization Review experience professional looking... ...: As the Utilization Review RN, you would be responsible for... ...years of experience in UM, UR, pre-authorization, concurrent...
Private practice
Monday to Friday
Healthcare Support Staffing
Brentwood, TN
4 days ago
Remote RN Utilization Review - Per Diem Day Shift
...Providence is seeking a Remote RN Utilization Review nurse to work Per Diem 8-hour day shifts. This role involves conducting utilization reviews, requiring a strong clinical background and knowledge in Utilization Management. Join Providence California Regional Services...
Remote work
Daily paid
Day shift
Providence Service
Mission Hills, CA
1 day ago
Remote Utilization Review RN - Hospital Admissions
...A leading healthcare organization is seeking a remote RN to ensure appropriate administration of hospital resources and quality care. Responsibilities include reviewing patient care levels and utilizing Interqual Criteria for inpatient hospitalizations. The ideal candidate...
Remote work
BJC HealthCare
Saint Louis, MO
4 days ago
Virtual Nurse (RN) Full Time
...COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...
Remote work
Full time
COMAGINE HEALTH
Seattle, WA
4 days ago
(RN) Care Review Clinician- Utilization Review (Remote, MS based)
$23.76 - $51.49 per hour
...SummaryProvides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. • Adheres to utilization management (UM) policies and procedures.... ...and experience. • Registered Nurse (RN). License must be active and unrestricted...
Remote work
Hourly pay
Work experience placement
Work at office
Molina Healthcare
United States
5 days ago
Remote Utilization Review RN Case Management Expert
...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
NeuroPsychiatric Hospitals
Indiana, PA
5 days ago
Healthcare Nurse - Remote
$1,949.74 per month
...Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay $1949.74 Shift... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...
Remote work
Weekly pay
Shift work
Cynet Health
Eureka, CA
10 hours ago
Healthcare Nurse - Remote
...health, access to care and appropriate utilization of resources, balanced with the patient’... ...oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central... ...Location DAYS: Tuesday thru Saturday schedule. Remote, but you must live locally in AZ. #J-188...
Remote work
Work at office
Santa Barbara Cottage Hospital
New York, NY
2 days ago
Utilities Maint Mech(Pre-Cert)
$18.09 - $23.27 per hour
...Utilities Maint Mech(Pre-Cert) Requisition ID req36230 Working Title Utilities Maint Mech(... ...contributions. For more information, review the Benefits Eligibility at a Glance... ...Consideration Date 4/15/2026 Eligible for Remote Work No Eligible for Remote...
Remote work
Hourly pay
Full time
Work experience placement
University of New Mexico
Albuquerque, NM
1 day ago
Remote Utilization Review RN | Hospital Admissions Expert
...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
BJC HealthCare
Kansas City, MO
10 hours ago
Remote Utilization Review Nurse (RN)
$47.06k - $70.24k
...A healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting... ...claims examiners. Candidates must have a current RN license and at least four years of clinical...
Remote work
Care Options For Kids
Fort Worth, TX
4 days ago
Remote RN Utilization Review Specialist - Part Time
...Providence Health & Services is seeking an RN Utilization Review for a part-time remote position. This role focuses on conducting clinical reviews and utilization reviews across Southern California ministries, requiring effective problem-solving and decision-making skills...
Remote work
Part time
Providence Health & Service
Mission Hills, CA
1 day ago
Remote Utilization Review RN - OASIS & Coding Expert
...Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification, and Home Health Coding Certification. You will be responsible for reviewing home health clinical documentation...
Remote work
Flexible hours
Weekend work
Weekday work
Santa Barbara Cottage Hospital
New York, NY
2 days ago
Remote RN Utilization Review Nurse (Per Diem)
...Providence Health Plan Group is seeking an RN for Utilization Review. This remote position requires strong clinical skills and knowledge in Utilization Management. Responsibilities include conducting reviews for Southern CA ministries and managing diverse workloads. Ideal...
Remote work
Daily paid
Part time
Shift work
Providence Health Plan Group
Irvine, CA
1 day ago
Remote RN Utilization Review Specialist (Per Diem)
...Providence Health Plan Group is seeking an RN Utilization Review for a remote, per diem position in Los Angeles. You will be responsible for conducting utilization reviews across Southern California ministries and require a strong clinical background. Ideal candidates...
Remote work
Daily paid
Providence Health Plan Group
Los Angeles, CA
2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN: Pharmacy Pre-Cert & Utilization Review. Be the first to apply!