Remote Prior Authorization Tech — DDI & Clinical Review
JobRx, Inc.
- Remote job
Gainwell Technologies in the United States is seeking a Pharmacy Support Specialist focused on prior authorization processing with emphasis on DDI screening and clinical accuracy. You will review medication profiles and collaborate with pharmacists to support reviews, escalations, and approvals. This fully remote role requires a high school diploma, Pharmacy Technician certification where required by state regulations, and 2+ years in PBM or pharmacy operations. #J-18808-Ljbffr JobRx, Inc.
$80k - $90k
...Range: $80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible... ...to work independently in remote setting with minimum... ...performing similar functions. Prior experience in role with responsibility... ...management or prior-authorization work, or review of audit work...Remote workFor contractorsImmediate startHome officeFlexible hoursShift work$57 per hour
ProPivotal Staffing is seeking a Clinical Pharmacist Reviewer to work from home in Massachusetts. This role supports clinical pharmacy services and involves optimizing treatments with healthcare teams. Candidates should have 1-2 years of experience and an active Massachusetts...Remote workHourly payWork from homeFlexible hours- ...Responsibilities: Reviews documentation and evaluates... ...Quality of Care issues based on clinical policies and benefit determinations... ...residence ~ Must have prior authorization utilization experience ~... ...License? About US Tech Solutions: US Tech Solutions...Remote work
- A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2-4 years experience in Prior...Remote jobContract work
- ...Barbara Cottage Hospital is seeking a clinical professional for a fully remote role focused on medical management... ...licensure and involves analyzing authorization requests to determine medical... ...healthcare providers, conduct clinical reviews, and ensure that members receive...Remote jobFlexible hours
- Maximus is hiring a Clinical Reviewer, RN/LPN to support the PASRR program in Tennessee. You will review clinical documentation and determine the appropriate level of care and prior authorization needs. This remote position requires candidates to reside in Tennessee and...Remote job
$28.37 - $39.19 per hour
...outcomes through technology, services, and clinical expertise. Our mission is to innovate... ...Health is looking for a Clinical Reviewer (SCA) to join our growing team. Job Summary... ...of Case Management, UR and/or Prior Authorization or related experience Experience in a...Remote jobContract workWork at officeLocal areaFlexible hours- ...Clinical Review Nurse - Remote ARC Group has multiple positions open for Clinical Review Nurses! These... ...currently have PERMANENT US work authorization. SUMMARY STATEMENT The Clinical Review... ...which may include cases requiring prior authorization, complex pre-payment...Remote workPermanent employmentWork at officeLocal area
- ...Title: Nurse RN 5 - Medical Necessity & Post-Service Clinical Review Nurse Location: Remote Duration: 3+ Month (Possible Extensions &... ...Qualifications Previous Post-Service Review experience Prior Authorization experience Case Management experience...Remote workContract workMonday to Friday
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical... ...suite applications This is a 100% remote role, and requires robust internet... ...the care continuum–including policy, prior authorization, payment accuracy, and more–the...Remote workFull timeFlexible hoursShift work$118.06k - $168.66k
...hardworking? We need great people to join our team. The Clinical Review Pharmacist ensures that members have access to medically necessary... ...in a cost‑effective, safe manner. This role completes prior authorizations for internal expert peer discussions on high‑cost...Remote jobFor contractorsWork at officeLocal areaWeekend workAfternoon shift- ...healthcare staffing firm is seeking a Pharmacy Technician to support retail pharmacy operations remotely. This role involves processing prescriptions, performing prior authorization reviews, and coordinating care for patients. Candidates should have at least 2 years in retail...Remote job
$110k - $140k
...Clinical Quality Reviewer - BCBA Onos Health's mission is simple but ambitious: ensure every healthcare... ...management, care review, or prior authorization review for a payer or managed care organization... ...office (Financial District), remote-first culture Unlimited vacation...Remote workWork at officeHome officeFlexible hours2 days per week3 days per week- Gainwell Technologies is seeking a skilled Utilization Review Nurse to conduct prior authorization and reviews for medical necessity, following clinical criteria and policies. This home-based role supports providers and requires accurate documentation and collaboration...Remote job
- ...solutions for treatment review and virtual care... ...and coordinates with clinical and non‑clinical staff... ...or mail. Intake Pre‑Authorization requests and/or inquiries... .... Experience working remotely and independently. Minimum... ...• OneUM - a single e‑Prior Authorization portal...Remote workMonday to FridayShift workWeekend work
- Glint Tech Solutions is looking for a Clinical Product Owner to lead cross-functional initiatives focused on the prior authorization process. This fully remote position requires over 15 years in healthcare delivery, specifically as a Clinical Product Manager. The role involves...Remote job
- ...Paid Sick Leave SUMMARY STATEMENT The Clinical Review Nurse is responsible for reviewing... ...care which may include cases requiring prior authorization, complex pre‑payment medical review... ...Protected Veteran/Disabled Employer. Remote Work Locations This opportunity is open...Remote jobPermanent employmentTemporary workWork at officeLocal areaImmediate start
$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers care, aided by technology... ...appeal hearings, defending MassHealth prior authorization decisions, and performing pre-service/prior authorization clinical coverage review of services. Works closely with...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- ...PHIL Clinical Support Associate Founded in 2015, PHIL is a health-tech startup that is building a platform that interfaces... ...inquiries per day. In this fully remote position, you will handle... ...workflows, assisting with prior authorizations, processing orders, and...Remote workWork at office
- CLINICAL PRODUCT OWNER (PRIOR AUTHORIZATIONS SME) COMPANY OVERVIEW Glint Tech Solutions is a women-owned global staffing and IT recruiting firm dedicated to connecting exceptional... ...process. This is a lead-level, fully remote position requiring a true SME in Prior Authorizations...Remote work
$50 - $60 per hour
A tech company specializing in AI is seeking a Clinical Reviewer to join their team. This role involves evaluating AI models and providing complex healthcare-related... ...of $50-$60 per hour with bonuses for high-quality work. Remote work is also available. #J-18808-LjbffrRemote workHourly pay$15.85 - $25.5 per hour
...Lead Clinical Pharmacy Technician The Clinical Pharmacy... ...Medication Reviews (CMRs) and Targeted Medication... ..., flu, strep Remote patient monitoring... ...clinical duties such as prior authorizations, patient messages, benefits... ...Board of Pharmacy or Tech in Training Certificate...Remote workHourly payImmediate startWeekend workAfternoon shift$19.37 - $27.71 per hour
...doctors, nurses, business people, tech experts, researchers, and... ...both administrative and clinical functions to support smooth... ...or takes messages related to prior authorizations, provider questions, prescription... ...Details (if applicable) Remote Type Onsite Work...Remote workHourly payFull timeWork at officeLocal areaMonday to FridayShift work$50 - $52 per hour
Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work... ...weekends if they prefer. Remote position. Equipment is... ...FPCC. Knowledge Service Authorization concepts, principles, and... ...design and implementation, prior authorization functions and...Remote workPart timeWork at officeLong distance10 hours per week$106.3k - $151.8k
...Summary The Leveraged Clinical Pharmacist reports to the PBM... ...of pharmacy programs through prior authorization (PA) criteria development,... ...Responsibilities Therapeutic Class Review (TCR) Development - Conduct... ...Traveling: 0-20%. Remote position; candidates may...Remote workFull timeWork at officeFlexible hours- ...quality improvement, and better health outcomes. Our remote workforce collaborates across the country to deliver meaningful... ...Analysis (ABA) Consultant to support a Medicaid Prior Authorization (PA) program reviewing ABA therapy services. In this role, the consultant...Remote workRelief
$68k - $71.03k
...Claims Clinical Documentation Reviewer Division of Fee for Service (DFSM) Job Location Address: 150 North 18th Avenue... ...flexibility, autonomy, and trust. Remote work is available within Arizona subject to prior authorization. Responsibilities Conduct Pre‑Payment Claim...Remote workFull timePart timeWork at officeLong distance$19.37 - $27.71 per hour
...doctors, nurses, business people, tech experts, researchers, and... ...MGH Voice Disorders Clinic Join a dynamic medical office... ...including surgical scheduling, prior authorizations, medical office coding and... ...Details (if applicable) Remote Type Onsite Work Location...Remote workHourly payWork at officeShift work- ...Clinical Reviewer, Precertification RN Duration: 8 months contract (with possible extension) The... ...schedule. *Note: Candidates can be remote but must have an active unrestricted Massachusetts RN License About US Tech Solutions: US Tech Solutions is a global...Remote workContract workWork at officeWork from home
$17.71 - $24.94 per hour
...doctors, nurses, business people, tech experts, researchers, and... ...We are seeking a part-time Clinic/Practice Assistant to join... ...or takes messages related to prior authorizations, provider questions,... ...Details (if applicable) Remote Type: Onsite Work Location...Remote workHourly payPart timeWork at officeShift work
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