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Remote Prior Authorization Rn Jobs in Washington, PA

TEEMA Group

Registered Nurse - RN

Pittsburgh, PA · Remote

$50 - $55/hr

We are seeking a dedicated Registered Nurse for a full-time position providing home health and ... Prior experience using HomeCare HomeBase (HCHB) software is strongly preferred. * Specialized Care ...

tenavistaffing

HEDIS Chart Retrieval Nurse

Pittsburgh, PA · Remote

$29.25 - $38.75/hr

Active Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license. * (compacted license ... Prior HEDIS, medical record retrieval, chart review, or chart abstraction experience preferred.

MCKESSON

Field Reimbursement Manager

Pittsburgh, PA · On-site +1

... Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

York Risk Services

RN Field Case Manager

Canonsburg, PA · On-site +1

$71K - $91K/yr

... Insurance RN Field Case Manager This Field Case Manager will cover West Pittsburg, PA region ... remote work environment that allows face to face interaction with injured workers and medical ...

York Risk Services

RN Field Case Manager

Pittsburgh, PA · On-site +1

$75K - $96K/yr

... Insurance RN Field Case Manager This Field Case Manager will cover West Pittsburg, PA region ... remote work environment that allows face to face interaction with injured workers and medical ...

Sedgwick

RN Field Case Manager

Pittsburgh, PA · On-site +1

$75K - $96K/yr

... Insurance RN Field Case Manager This Field Case Manager will cover West Pittsburg, PA region ... remote work environment that allows face to face interaction with injured workers and medical ...

Sedgwick

RN Field Case Manager

Canonsburg, PA · On-site +1

$71K - $91K/yr

... Insurance RN Field Case Manager This Field Case Manager will cover West Pittsburg, PA region ... remote work environment that allows face to face interaction with injured workers and medical ...

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All JobsPrior Authorization Rn JobsRemote Prior Authorization Rn JobsRemote Prior Authorization Rn Jobs in Washington, PA

Remote Prior Authorization Rn information

See Washington, PA salary details

$6

$39

$67

How much do remote prior authorization rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for remote prior authorization rn in Washington, PA is $39.26, according to ZipRecruiter salary data. Most workers in this role earn between $29.28 and $46.44 per hour, depending on experience, location, and employer.

What is the difference between Remote Prior Authorization Rn vs Remote Medical Coder?

AspectRemote Prior Authorization RnRemote Medical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), high school diploma or equivalent
Work EnvironmentHealthcare facilities, insurance companies, telehealthMedical offices, insurance companies, remote coding platforms
Industry UsageUtilization review, patient authorization, insurance approvalMedical record review, billing, coding for insurance claims

Remote Prior Authorization Rns focus on reviewing patient information to approve treatments, while Remote Medical Coders translate medical records into codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare industry.

What are popular job titles related to Remote Prior Authorization Rn jobs in Washington, PA?

For Remote Prior Authorization Rn jobs in Washington, PA, the most frequently searched job titles are:

What job categories do people searching Remote Prior Authorization Rn jobs in Washington, PA look for?

The top searched job categories for Remote Prior Authorization Rn jobs in Washington, PA are:

What cities near Washington, PA are hiring for Remote Prior Authorization Rn jobs?

Cities near Washington, PA with the most Remote Prior Authorization Rn job openings:

Remote Prior Authorization Rn jobs near you
Infographic showing various Remote Prior Authorization Rn job openings in Washington, PA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $81,652 per year, or $39.3 per hour.

Pharmacy Clinical Review Specialist- Remote

UPMC Health Plan

Pittsburgh, PA • Remote

$122K - $142K/yr

Full-time

Medical

Posted 11 days ago

Job description

The Clinical Review Specialist will oversee administrative and system processes that relate to pharmacy prior authorizations. Manage the first line clinical review of prior authorization requests on behalf of physicians and UPMC Health Plan members. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations. Schedule is 11:30am-8:00 pm, Monday-Friday with a Saturday rotation monthly. Training schedule will be 8:30am-5:00 pm Monday-Friday. Equipment will be provided. As this position is remote, please understand that we do have the ability to have staff report to and work from our primary location, US Steel Tower as well.

Responsibilities:

  • Provide excellent internal and external customer service maintaining a second requests for information and customer complaint goal of zero.
  • Act as a conduit of information between the Pharmacy Service Representatives and the clinical staff
  • Subject matter expert on formulary exceptions and prior authorization requirements/time frames according to line of business.
  • Perform peer reviews of prior authorization requests.
  • Maintain or exceed designated quality and production standards.
  • Develop and maintain the pre-logic and clinical criteria in support of the prior authorization determination process.
  • Interface with other departments and identify medical documentation in support of prior authorization requests.
  • Complete standard/expedited pharmacy coverage determinations according to departmental/government guidelines.
  • Report and respond to escalate issues and concerns in a within twenty-four hours.
  • Process requests and inquiries in accordance with all governing regulatory agencies including but not limited to CMS, DPW, DHHS, HCFA, DOI and NCQA laws and standards.
  • HS diploma and pharmacy claims, pharmacy tech, and/or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.
  • Competent in pharmacy claims process operating system.
  • Excellent knowledge in UPMC's Health Plan internal department functions.
  • Excellent knowledge of medical terminology, coordination of benefits, complaints and grievance guidelines and prescription drug utilization management requirements.
  • Thorough knowledge in MS Office and PC skills required.
  • Organizational, analytical, interpersonal, and communication skills.
  • Ability to prioritize and perform multiple tasks while maintaining designated production and quality standards.
  • Staff is required to work scheduled overtime and be available for emergency overtime as business needs dictate.
  • Staff is required to work a temporary, alternative schedule or shift as requested by supervisor.
    Licensure, Certifications, and Clearances:
  • Act 34


UPMC is an Equal Opportunity Employer/Disability/Veteran

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