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Remote Nicu Utilization Review Jobs in Nevada (NOW HIRING)

P3 Health Partners

RN Concurrent Review

Henderson, NV · On-site +1

$90K - $100K/yr

... care. The UM Nurse will integrate the functions of utilization review, discharge planning and ... Work Location & Schedule This role offers either a hybrid or fully remote work arrangement.

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Henderson, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Henderson, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

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 (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Mesquite, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

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 (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review ...

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Remote Nicu Utilization Review information

What are the key skills and qualifications needed to thrive as a Remote NICU Utilization Review Nurse, and why are they important?

To excel as a Remote NICU Utilization Review Nurse, you need a valid RN license, strong clinical expertise in neonatal intensive care, and experience with utilization management practices. Familiarity with case management software, electronic health records (EHRs), and UR-specific platforms such as InterQual or MCG is essential. Outstanding critical thinking, attention to detail, and effective written and verbal communication set top performers apart. These skills ensure accurate assessments, regulatory compliance, and optimized patient outcomes while working remotely in a highly specialized healthcare environment.

What are some common challenges faced in a remote NICU Utilization Review role and how can they be managed?

In a remote NICU Utilization Review position, professionals often encounter challenges such as ensuring thorough communication with clinical teams, navigating different electronic health record (EHR) systems, and maintaining up-to-date knowledge of evolving NICU care standards. Successfully managing these challenges typically involves establishing clear communication channels with onsite staff, participating in regular virtual team meetings, and dedicating time for ongoing education and training. Proficiency in telehealth technologies and strong organizational skills are also essential for accurate documentation and timely case reviews.

What is a Remote NICU Utilization Review nurse?

A Remote NICU Utilization Review nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of care provided to newborns in Neonatal Intensive Care Units (NICU) from a remote location. They review patient records, treatment plans, and hospital stays to ensure that the care provided meets established clinical guidelines and insurance policies. This role helps optimize patient outcomes, control healthcare costs, and facilitate communication between healthcare providers, insurers, and families. Working remotely, these nurses use secure digital platforms to access medical records and collaborate with medical teams.

What is the difference between Remote Nicu Utilization Review vs Remote Pediatric Utilization Review?

AspectRemote Nicu Utilization ReviewRemote Pediatric Utilization Review
CredentialsRN, NICU experience, utilization review certificationRN, pediatric experience, utilization review certification
Work EnvironmentHome-based, healthcare facilities, insurance companiesHome-based, healthcare facilities, insurance companies
Industry UsageHospitals, insurance, healthcare managementHospitals, insurance, healthcare management
Search IntentCompare roles, job requirements, salary, responsibilitiesCompare roles, job requirements, salary, responsibilities

Remote Nicu Utilization Review involves evaluating NICU patient cases to ensure appropriate care and resource use, requiring NICU experience. Remote Pediatric Utilization Review focuses on pediatric cases, requiring pediatric nursing background. Both roles involve reviewing medical necessity and optimizing healthcare resources remotely within the healthcare and insurance industries.

What are the most commonly searched types of Nicu Utilization Review jobs in Nevada? The most popular types of Nicu Utilization Review jobs in Nevada are:
What are popular job titles related to Remote Nicu Utilization Review jobs in Nevada? For Remote Nicu Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Remote Nicu Utilization Review jobs in Nevada look for? The top searched job categories for Remote Nicu Utilization Review jobs in Nevada are:
What cities in Nevada are hiring for Remote Nicu Utilization Review jobs? Cities in Nevada with the most Remote Nicu Utilization Review job openings:
Remote Nicu Utilization Review jobs near you

Drug Utilization Review Pharmacist

Pharmacy Careers

Las Vegas, NV • On-site, Remote

Other

Medical

Posted 6 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.

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