Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential ... Many DUR roles offer hybrid or fully remote schedules. * Rewards: Competitive salary, benefits, and ...
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential ... Many DUR roles offer hybrid or fully remote schedules. * Rewards: Competitive salary, benefits, and ...
Drug Utilization Review Pharmacist
Las Vegas, NV · On-site +1
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential ... Many DUR roles offer hybrid or fully remote schedules. * Rewards: Competitive salary, benefits, and ...
Drug Utilization Review Pharmacist
Las Vegas, NV · On-site +1
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential ... Many DUR roles offer hybrid or fully remote schedules. * Rewards: Competitive salary, benefits, and ...
... reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance ... Location: 100% Remote Reporting to the Chief Medical Officer, the Medical Director focuses on ...
... reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance ... Location: 100% Remote Reporting to the Chief Medical Officer, the Medical Director focuses on ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
North Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
North Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Boulder City, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Boulder City, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Reno, NV · Remote
$30.50 - $59.47/hr
... utilization management and long-term services and supports (LTSS) issues. + Identifies and reports ... insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Reno, NV · Remote
$30.50 - $59.47/hr
... utilization management and long-term services and supports (LTSS) issues. + Identifies and reports ... insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Sparks, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Sparks, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
North Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
North Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Henderson, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Medical Review Nurse (RN)
Las Vegas, NV · Remote
$30.50 - $59.47/hr
Resolves escalated complaints regarding utilization management and long-term services and supports ... insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical ...
Remote Insurance Utilization Review information
What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?
To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?
Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.
What are remote insurance utilization review jobs?
Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.
What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?
| Aspect | Remote Insurance Utilization Review | Remote Claims Reviewer |
|---|---|---|
| Credentials | Typically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professional | Usually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H |
| Work Environment | Remote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of services | Remote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance |
| Industry Usage | Commonly used in healthcare insurance to evaluate medical necessity | Used across insurance sectors to process and validate claims |
Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.
What are popular job titles related to Remote Insurance Utilization Review jobs in Nevada? For Remote Insurance Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Nevada look for? The top searched job categories for Remote Insurance Utilization Review jobs in Nevada are:
- Occupational Therapy Utilization Review
- Remote Triage Coordinator
- Locum Medical Chart Review
- Remote Motivational Interviewing
- Remote Behavioral Science Associates Degree
- Patient Assistance Coordinator
- Patient Intake Coordinator
- Clinical Review Coordinator
- Remote Patient Access Director
- Referral Coordinator Remote
What cities in Nevada are hiring for Remote Insurance Utilization Review jobs? Cities in Nevada with the most Remote Insurance Utilization Review job openings:
Other
Medical
Posted 9 days ago
Job description
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications
A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care.
Key Responsibilities
- Conduct prospective, concurrent, and retrospective drug utilization reviews.
- Evaluate prescribing patterns against clinical guidelines and formulary criteria.
- Identify potential drug interactions, duplications, and inappropriate therapy.
- Prepare recommendations for prescribers to optimize therapy and reduce risk.
- Document reviews and ensure compliance with state, federal, and health plan requirements.
- Contribute to quality improvement initiatives and pharmacy program development.
What You'll Bring
- Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
- Licensure: Active and unrestricted pharmacist license in the U.S.
- Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply.
- Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication.
Why This Role?
- Impact: Shape prescribing decisions that affect thousands of patients.
- Growth: Build expertise in managed care and population health pharmacy.
- Flexibility: Many DUR roles offer hybrid or fully remote schedules.
- Rewards: Competitive salary, benefits, and career advancement opportunities.
About Us
We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations.
Apply Today
Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.