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Remote Rn Case Review Jobs in Virginia (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Annandale, VA · On-site +1

$57 - $69.50/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Ashburn, VA · On-site +1

$58.50 - $71.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Corvel

Advocacy 24-7 Triage Nurse

Glen Allen, VA · Remote

$25.48 - $41.09/hr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Provides telephonic assessment and ... Obtains and maintains licensure as a Registered Nurse in 50 states and the District of Columbia

North American Partners in Anesthesia

$310K/yr

Awards Case Assignments Diverse case mix. Shifts As part of our Implementation Team, you will find ... A may be used up to one weekend per month in either a call capacity or as a regularly scheduled ...

Veterans Health Administration

Nurse

Fredericksburg, VA · On-site +1

$82K - $228K/yr

Summary Fredericksburg HCC is recruiting for Registered Nurse (RN) -Surgical Nurse Navigator. This ... Surgical Nurse Navigator should possess recent clinical/case management/care coordination ...

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Remote Rn Case Review information

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

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What cities in Virginia are hiring for Remote Rn Case Review jobs? Cities in Virginia with the most Remote Rn Case Review job openings:
Remote Rn Case Review jobs near you

Appeals Pharmacist (Remote)

Pharmacy Careers

Annandale, VA • On-site, Remote

$57 - $69.50/hr

Other

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

Job description

Appeals Pharmacist - Ensure Fair Medication Access for Patients
A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.
Key Responsibilities

  • Review clinical documentation for medication coverage appeals and grievances.
  • Apply evidence-based guidelines, plan policies, and regulatory requirements to determine outcomes.
  • Prepare written clinical rationales to support appeal determinations.
  • Collaborate with physicians, nurses, and medical directors during case reviews.
  • Track, document, and report appeal outcomes in compliance with state and federal regulations.
  • Support process improvements to enhance timeliness and quality of appeal decisions.


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: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply.
  • Skills: Excellent clinical judgment, written communication, and attention to regulatory detail.


Why This Role?

  • Impact: Play a critical role in ensuring patients get fair access to necessary medications.
  • Growth: Gain expertise in appeals, utilization management, and managed care pharmacy.
  • Flexibility: Many roles offer hybrid or fully remote options.
  • Rewards: Competitive salary, comprehensive benefits, and opportunities for advancement.


About Us
We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.
Apply Today
Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.

Apply