Remote RN: Pharmacy Pre-Cert & Utilization Review
Quantum Corporation
- Remote job
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 Quantum Corporation
- ...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 workPermanent employmentCasual workWork at office
$65 per hour
...RN Utilization Review Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule... ...accepted: Yes Weekends Required: No Certs Required: BLS, WA RN License Will this... ...No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend work$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 workHourly payFull timeContract workImmediate startShift work3 days per week$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 workHourly payFull timeContract workImmediate startShift work3 days per week$69.38k - $92.28k
MVP Health Care seeks a Professional Concurrent Review RN to ensure members receive appropriate care while navigating the healthcare continuum... ...candidates are experienced RNs looking to transition into utilization management, requiring strong clinical judgment and excellent...Remote job- ...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 practiceMonday to Friday
- ...Utilization Management Position Provide health care services regarding admissions, case management, discharge planning and utilization review. Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity...Remote work
- Providence Health & Services is hiring a Utilization Review RN for a remote position focused on administering medical management programs, including prior authorization and review processes. Candidates must have a strong clinical nursing background with 5 years of experience...Remote job
$211.2k - $277.2k
...Physician Reviewer - Utilization Management You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence... .... Work Location: This is a remote position, open to candidates who reside...Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...Description Job Description POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key contributor to the delivery of appropriate,... ...preferred. • Basic Life Support (BLS) certification as required for facility based staff; optional for remote staff....Remote workWork at office
$30.64 - $45.8 per hour
...Job Description The Utilization Review Nurse gathers demographic... ...CorVel. This is a remote position. ESSENTIAL... ...operation required; RN is required unless local... ...Medical (HDHP) w/Pharmacy, Dental, Vision, Long... ...Critical Illness Insurance, Pre-paid Legal Insurance,...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...RN Utilization Review - Remote Position This position will work full-time, 8-hour day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during...Remote jobFull timeLocal areaDay shift
$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 60936 Overview Salary Range $32.00 - $48.00 Hourly Position... ...REQUIREMENTS: Full time position. Hybrid (combination of in person and remote considered) GENERAL SUMMARY The Utilization Review/...Remote workHourly payFull timeWork at officeRelocation packageShift work- ...CDI Quality Review Nurse With over 75 years... ...a post-discharge, pre-coding/billing basis... ...Certifications (RN) REGISTERED NURSE Upon... ...Hire and (CCDS) Cert Clinical Documentation... ...working in a remote environment Job... ..., as applicable Utilize methodology-specific...Remote workFull timeShift work
$38.91 - $60.31 per hour
...not offer a hybrid or remote option Minimum Requirements... ...as a Registered Nurse (RN). ~6 months RN... ...in direct patient care utilizing the nursing process... ...cost of living. Market reviews: All UCHealth positions... ...for up to $10,000/year pre-paid by UCHealth or up...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$38.91 - $60.31 per hour
...not offer a hybrid or remote option Minimum Requirements... ...as a Registered Nurse (RN). ~6 months RN... ...in direct patient care utilizing the nursing process... ...cost of living. Market reviews: All UCHealth positions... ...for up to $10,000/year pre-paid by UCHealth or up...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$37.06 - $57.44 per hour
...not offer a hybrid or remote option Summary: Provides... ...Performs and documents pre/post procedure... ...threatening situations utilizing nursing standards and protocols... ...as a Registered Nurse (RN). Basic Life Support (... ...of living. Market reviews: All UCHealth positions...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$38.91 - $60.31 per hour
...not offer a hybrid or remote option Minimum Requirements... ...as a Registered Nurse (RN). Basic Life Support (... ...in direct patient care utilizing the nursing process... ...of living. Market reviews: All UCHealth positions... ...for up to $10,000/year pre-paid by UCHealth or up...Remote workTemporary workReliefLocal areaFlexible hoursShift work$20.38 - $36.44 per hour
...Utilization Review Specialist (LVN) Explore opportunities with Kelsey-Seybold Clinic, part of... ...you will have the flexibility to work remotely as you take on some tough challenges.... ...companies to obtain authorizations and pre-certification for medical services Consistent...Remote jobHourly payMinimum wageFull timeWork experience placementLocal areaFlexible hours$38.91 - $60.31 per hour
...recent procedural/cath lab pre/recovery, PACU, or ED, or CICU, or cardiac RN experience strongly... ...does not offer a hybrid or remote option Summary:... ...threatening situations utilizing nursing standards and protocols... ...of living. Market reviews: All UCHealth positions...Remote workTemporary workReliefLocal areaFlexible hoursShift workRotating shiftDay shift$73.86k - $96.02k
...initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team... ...within this role include: Screens pre-admission, admission process using... ...their non-leadership role as an RN. however, they are required to complete...Remote jobLocal area$29 - $52 per hour
...Clinical Claim Review Nurse Optum is a global organization... ...connecting people with the care, pharmacy benefits, data and... ...~ Active and unrestricted RN license in the state of residence... ...one of the following areas Utilization Management, pre-authorization, claim review...Remote workHourly payMinimum wageFull timeContract workTemporary workWork experience placementWork at officeLocal area- ...Mississippi Medical Center. Please review the following instructions prior... ...Nursing Organization: Utilization Review Location/s: Main... ...Campus Jackson Job Title: RN - Utilization Reviewer - Coordinated Care - PT - Remote Job Summary: Accountable...Remote workPart timeWork experience placementCasual workSeasonal workShift work
- ...Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential... ...to quality improvement initiatives and pharmacy program development. What You'll... ...Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive...Remote work
- ...The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility... ...procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This...Remote workWork at officeLocal areaWork from homeHome officeMonday to Friday
- ...Role: Clinical RN I - Pre/Post Pay Audit Location: Remote (NJ, NY, PA, CT, DE) Job Summary Performs pre... ...audits using standard guidelines Review claims, clinical documentation,... ...ASN or BSN Experience in utilization review, clinical audits, or documentation...Remote work
- ...Arizona Department Name: Utilization Mgmt Work Shift: Day... ...Canyon State. As an RN Utilization Management Care Reviewer, you will be an important... ...Networks Team. This 100% remote role manages a typical... ...determinations. In addition to pre-service, admission, and...Remote workFull timeMonday to FridayShift work
- ...Holidays ~ Work-life balance. ~ Remote/hybrid setting (once trained)... ...: This individual will utilize clinical knowledge and... ...defer decision to a second level reviewer. This individual interfaces with... ...includes but is not limited to RN, LMSW, LMHC. # Must have Mental...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
- ...OH, is seeking an Entry Level Registered Nurse for their Pre-Certification Pharmacy Review role. This position involves reviewing and processing coverage... ...disciplinary clinical team. Ideal candidates will hold an RN license, have strong critical thinking and communication...Full time
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location:... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications... ..., active, and unrestricted RN license Certifications: BLS... ...Utilization Management, Utilization Review, or Case Management...Remote workContract workImmediate startMonday to Friday
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