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Overnight Remote Utilization Review Jobs in Minnesota

Monitor project costs, productivity, and resource utilization and implement corrective actions when ... remote and field-based position requiring regular travel to project and client locations. Overnight ...

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Overnight Remote Utilization Review information

What is an overnight remote utilization review?

An Overnight Remote Utilization Review position involves evaluating medical records and healthcare services during nighttime hours to ensure that treatments are medically necessary and meet established guidelines. Professionals in this role usually work from home, reviewing patient cases, authorizing or denying services, and collaborating with healthcare providers. This job is crucial for maintaining quality care while controlling healthcare costs, and it often requires clinical credentials such as RN, LPN, or other relevant certifications. Strong analytical, communication, and computer skills are important for success in this remote role.

What are the key skills and qualifications needed to thrive as an overnight remote utilization review?

To thrive as an Overnight Remote Utilization Review nurse, you need a current RN license, strong clinical judgment, and experience in acute care or case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare/Medicaid are typically required. Excellent critical thinking, attention to detail, and the ability to communicate clearly in written and verbal forms are vital soft skills for this role. These skills ensure accurate, timely case reviews and effective collaboration with healthcare providers while maintaining compliance with payer requirements.

What are the main challenges faced by overnight remote utilization review professionals, and how can they be addressed?

Overnight remote utilization review professionals often encounter challenges such as working independently during non-traditional hours, limited immediate access to colleagues or supervisors, and the need to make timely decisions with potentially less available support. To address these challenges, it is important to develop strong self-management skills, establish clear communication channels with team members, and utilize comprehensive digital resources and documentation. Employers typically provide thorough training and access to on-call support to help ensure that overnight staff can make confident, accurate determinations and maintain high-quality patient care standards.

What is the difference between Overnight Remote Utilization Review vs Daytime Remote Utilization Review?

AspectOvernight Remote Utilization ReviewDaytime Remote Utilization Review
Work HoursTypically overnight shifts, often 10 PM to 6 AMStandard daytime hours, usually 8 AM to 4 PM
CertificationsSame as utilization review roles, e.g., RN, CPC, or other healthcare credentialsSame as overnight roles, requiring similar certifications
Work EnvironmentRemote, focused on reviewing cases during night hoursRemote, reviewing cases during daytime hours
Employer & IndustryHealthcare insurance companies, third-party administratorsSame as overnight, within healthcare and insurance sectors

Overnight Remote Utilization Review involves reviewing cases during night hours, providing flexibility for healthcare providers and insurers. Daytime Remote Utilization Review occurs during regular business hours. Both roles require similar credentials and work environments but differ mainly in shift timing, catering to different operational needs.

What are the most commonly searched types of Remote Utilization Review jobs in Minnesota?

The most popular types of Remote Utilization Review jobs in Minnesota are:

What cities in Minnesota are hiring for Overnight Remote Utilization Review jobs?

Cities in Minnesota with the most Overnight Remote Utilization Review job openings:

340B Program Director

Visante Consulting LLC

Saint Paul, MN โ€ข Remote

Full-time

This job post hasย expired today.ย Applications are no longer accepted.


Job description

Description

ABOUT VISANTE
We are relentless in solving the most complex challenges in health system pharmacyโ€”designing pharmacy footprints that meet our clients where they are today and position them to win tomorrow. Our work delivers measurable financial gains, operational excellence, and an elevated patient experience.

We set ambitious goals, move with urgency, and create extraordinary value. Obsessed with client impact, we thrive in a collaborative, innovative culture where deep expertise turns insight into action. Weโ€™re proud of the results we deliver and the trust we earnโ€”fueling sustained growth and exceptional client satisfaction.


Our mission is to transform healthcare through pharmacy, and our vision is to reimagine pharmacy to improve lives.


ABOUT THE POSITION  (Remote, work from home)

The 340B Program Director, Pharmacy Services will lead the strategic design, development, and management of Visante, Inc.โ€™s 340B consulting services, specifically focusing on pharmacy-related aspects of the program. This role is responsible for ensuring compliance with all federal, state, and organizational regulations related to the 340B Program, including pharmacy utilization, purchasing, inventory management, and software integration. The Director will collaborate closely with clients to optimize their 340B program operations, ensuring that covered entities maintain program qualifications, implement best practices, and achieve the highest levels of efficiency and compliance. This position will also provide expert guidance to pharmacy staff, support audits, and manage reporting to ensure the accurate delivery of 340B services across various pharmacy settings, including mixed-use, retail-owned, and contract pharmacies.


Principle Duties and Responsibilities  

  • Lead the design, implementation, and ongoing management of the 340B Program within pharmacy settings, ensuring   compliance with federal, state, and organizational regulations. Maintain up-to-date knowledge of 340B policies and best practices to guide program operations.
  • Provide expert guidance and support to pharmacy teams in managing 340B operations, including purchasing, inventory   management, and claims adjudication. Ensure the accuracy and efficiency of pharmacy processes related to the 340B Program
  • Oversee and conduct regular audits to assess 340B compliance across pharmacy settings. Ensure that all necessary reports, including utilization reports and inventory tracking, are generated accurately and timely for client review and regulatory compliance.
  • Develop and deliver ongoing training and educational materials for pharmacy staff, ensuring they are well-versed in 340B regulations, software systems, and operational procedures to maintain compliance.
  • Oversee the proper functioning of 340B software systems, including the integration and maintenance of the CDM/crosswalks for new products/NDCs and product changes. Ensure the accuracy and efficiency of system-generated utilization reports.
  • Identify opportunities for cost savings and process improvements in 340B pharmacy utilization, inventory management, and   purchasing practices. Develop and implement strategies to enhance program performance.
  • Stay   current on changes in 340B regulations and ensure that pharmacy practices   adapt to new requirements. Provide guidance to clients on how to align their operations with regulatory changes.
  • Communicate clearly and effectively with clients, pharmacy teams, and internal stakeholders, both verbally and in writing. Maintain thorough and accurate documentation of program activities, audits, and compliance efforts.
  • Proactively identify challenges within the 340B Program and implement solutions to resolve issues related to program   compliance, operational efficiency, and client satisfaction.
  • Work closely with clients to troubleshoot issues, provide advice on program optimization, and ensure smooth integration of 340B processes. Maintain strong relationships to support long-term program success.

Requirements

Education

Required: Bachelor\'s degree in Pharmacy, Business or Healthcare   

Preferred:  

Experience

Required:  Minimum 5 years of work-related experience in a pharmacy setting.  Minimum of 4 years of managing 340B Programs 


Special Skills:  

  • Skilled in Windows OS and Microsoft Office Suite (Word, Excel, PowerPoint), with familiarity in pharmacy dispensing and 340B split-billing software.
  • Over 5 years of hands-on experience in hospital or retail pharmacy settings, with deep knowledge of 340B regulations, software integration, purchasing, billing, and contract pharmacy administration.
  • Clear verbal and written communicator with the ability to lead, influence, and build long-term relationships across teams and clients.
  • Demonstrates accuracy, timeliness, discretion, and professionalism in identifying and resolving operational issues independently.
  • Personable and socially adept, with a flexible, cooperative attitude and a commitment to client satisfaction and team success.


Compensation and Benefits: We offer competitive salary and benefits for this full-time salaried role.


Equal Opportunity Statement: Visante is an equal opportunity employer. Visanteโ€™s people are its greatest asset and provide the resources that have made the company what it is today. Visante is, therefore, committed to maintaining an environment free of discrimination, harassment, and violence. This means there can be no deference because of age, religion or creed, gender, gender identity or expression, race, color, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by applicable laws and regulations