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Remote Prior Authorization Rn Jobs in Worcester, MA

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site +1

$22.25 - $29/hr

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

VIVA USA INC

Nurse Case Manager

Woonsocket, RI · On-site +1

Case Management Certification CCM preferred Requires an RN with unrestricted active license in Georgia. REQUIRED : Must have experience working a remote position previously. Must have case management ...

VIVA USA INC

Nurse Case Manager

Woonsocket, RI · On-site +1

Case Management Certification CCM preferred Requires an RN with unrestricted active license in Georgia. REQUIRED : Must have experience working a remote position previously. Must have case management ...

Madrigal Pharmaceuticals

Patient Access Manager

Waltham, MA · Remote

$136K - $167K/yr

Conduct benefit investigations, verify coverage, and facilitate prior authorization, denial, and ... Proficiency in Salesforce CRM. #LI-Remote Madrigal's Total Rewards strategy is based on a biotech ...

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Remote Prior Authorization Rn information

See Worcester, MA salary details

$7

$42

$71

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

As of Aug 11, 2026, the average hourly pay for remote prior authorization rn in Worcester, MA is $42.15, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $49.90 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 Worcester, MA? For Remote Prior Authorization Rn jobs in Worcester, MA, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Rn jobs in Worcester, MA look for? The top searched job categories for Remote Prior Authorization Rn jobs in Worcester, MA are:
What cities near Worcester, MA are hiring for Remote Prior Authorization Rn jobs? Cities near Worcester, MA 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 Worcester, MA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $87,676 per year, or $42.2 per hour.

Remote Pharmacist - Prior Authorization / Coverage Determination

A-Line Staffing Solutions

Woonsocket, RI • Remote

$53/hr

Full-time

Medical, Dental, Vision

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Remote Pharmacist – Prior Authorization / Coverage Determination

Pay Rate: $53.00/hr

Start Dates

  • September 7
  • September 28

Training Requirements

  • Mandatory paid training is held Monday – Friday, 9:00 AM – 5:30 PM EST for approximately 8–10 weeks.
  • Attendance is mandatory during training. No planned vacation or scheduling conflicts are permitted during this period.
  • Candidates must be available for the entire training schedule before accepting the assignment.
  • Camera must remain on during all virtual training sessions, supervisor meetings, and team meetings.

Schedule

Business Hours:

  • Monday – Friday: 7:00 AM – 8:00 PM EST
  • Saturday & Sunday: 7:00 AM – 4:30 PM EST

Schedule Type: Set Rotation

After training, candidates will be assigned an 8-hour shift based on business needs, which will include either:

  • One weekend day each week, or
  • A rotating weekend schedule.


Job Summary

We are seeking a licensed Registered Pharmacist to support a high-volume, remote Prior Authorization and Coverage Determination team. This role is responsible for reviewing pharmacy benefit requests, interpreting clinical criteria, evaluating Medicare Part D coverage determinations, and ensuring accurate, timely decisions while maintaining compliance with regulatory requirements.

The ideal candidate has experience in Pharmacy Benefit Management (PBM), prior authorizations, managed care, or clinical pharmacy operations and thrives in a productivity-driven remote environment with strict turnaround times.

This is a Safety Sensitive position.

Key Responsibilities

  • Review and evaluate prior authorization and coverage determination requests.
  • Interpret Medicare Part D guidelines, formulary requirements, and clinical criteria.
  • Apply evidence-based clinical judgment using drug information resources and clinical compendia.
  • Ensure compliance with CMS regulations, plan policies, and pharmacy benefit guidelines.
  • Document case reviews accurately and maintain audit-ready records.
  • Manage a high-volume case queue while meeting quality and productivity standards.
  • Perform provider outreach as needed to obtain clinical information or clarify requests.
  • Navigate multiple applications simultaneously while documenting case activity.
  • Work independently in a fast-paced remote environment with minimal supervision.
  • Participate in virtual meetings, coaching sessions, and required training.

Required Qualifications

  • Active Registered Pharmacist (RPh) license in good standing in the state of residence.
  • Experience with:
    • Pharmacy Benefit Management (PBM)
    • Prior Authorizations
    • Coverage Determinations
    • Medicare Part D
    • Formulary management
    • Drug Utilization Review (DUR)
  • Strong understanding of CMS regulations and managed care pharmacy.
  • Excellent documentation and data entry skills.
  • Experience working in high-volume, productivity-driven environments.
  • Strong computer skills, including Microsoft Excel and Word.
  • Ability to navigate multiple computer applications using dual monitors.

Preferred Qualifications

  • Experience with provider outreach and clinical case review.
  • Retail pharmacy combined with managed care or PBM experience.
  • Knowledge of Microsoft Access, PowerPoint, and Visio.
  • Previous remote clinical review experience.

Remote Work Requirements

Candidates must have:

  • A dedicated, quiet workspace free from interruptions.
  • Wired high-speed internet with a minimum of:
    • 25 Mbps download
    • 5 Mbps upload
  • Dual-monitor capability.
  • Ability to remain seated and focused throughout the workday.

Additional Requirements

  • Virtual interviews are conducted through Microsoft Teams.
  • Candidates must be comfortable with extensive data entry, multitasking, and working independently while maintaining productivity standards.
  • Opportunity for full-time employment based on performance.
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About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

Social media

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