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Remote Utilization Management Pharmacist Jobs in Florida

Liberty Dental Plan Careers

Senior Staff Dentist

Tampa, FL · Remote

$175K - $185K/yr

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims ... Remote role with collaboration across national teams * High-impact role shaping clinical standards ...

LIBERTY DENTAL

Senior Staff Dentist

Tampa, FL · On-site +1

$175K - $185K/yr

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims ... Remote role with collaboration across national teams * High-impact role shaping clinical standards ...

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Remote Utilization Management Pharmacist information

How does a remote utilization management pharmacist typically collaborate with other healthcare professionals while working offsite?

Remote Utilization Management Pharmacists work closely with physicians, nurses, and case managers primarily through secure digital platforms and regular conference calls. They review medication requests, provide clinical recommendations, and help ensure patients receive appropriate therapies in line with established guidelines. Effective communication and timely documentation are essential, as collaboration often relies on electronic health records and virtual meetings. Building strong professional relationships remotely can be a challenge, but most organizations provide robust digital tools and dedicated support teams to facilitate seamless interaction.

What are the key skills and qualifications needed to thrive as a remote utilization management pharmacist, and why are they important?

To thrive as a Remote Utilization Management Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, active pharmacist licensure, and experience in medication review and clinical decision-making. Familiarity with pharmacy benefit management (PBM) systems, electronic health records (EHRs), and utilization management software is typically required. Strong analytical skills, attention to detail, and effective written communication are vital for evaluating medication requests and collaborating with healthcare providers. These competencies ensure appropriate medication use, regulatory compliance, and optimal patient outcomes in a remote healthcare setting.

What is a remote utilization management pharmacist?

A Remote Utilization Management Pharmacist is a licensed pharmacist who works from a non-traditional setting, such as home, to review medication use and ensure that prescribed drugs are medically necessary, cost-effective, and aligned with clinical guidelines. They collaborate with healthcare providers, insurance companies, and patients to optimize medication therapy while controlling costs and preventing unnecessary treatments. Their work often involves evaluating prior authorization requests, reviewing patient medication histories, and providing recommendations for alternative therapies when appropriate.

What is the difference between Remote Utilization Management Pharmacist vs Remote Pharmacy Benefits Manager?

AspectRemote Utilization Management PharmacistRemote Pharmacy Benefits Manager
CredentialsPharmacy license, certification in utilization reviewPharmacy license, health plan or benefits management experience
Work EnvironmentHealthcare organizations, insurance companies, telehealth platformsHealth insurance companies, pharmacy benefit management firms
Industry UsageFocuses on medication review, prior authorizations, and clinical decision supportOversees pharmacy benefit plans, formulary management, and cost control strategies

While both roles involve pharmacy expertise and work remotely, the Remote Utilization Management Pharmacist primarily reviews medication appropriateness and manages prior authorizations, whereas the Remote Pharmacy Benefits Manager focuses on managing pharmacy benefit plans and formulary strategies. Understanding these distinctions helps professionals choose the role that best aligns with their skills and career goals.

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

Remote Utilization Review RN (Hospital-Based Experience Required)

HealthPlus Staffing

Fort Lauderdale, FL • Remote

$80K - $105K/yr

Full-time

Posted 8 days ago

Job description

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard Business Hours

Job Requirements:
  • Active RN license with Multi-State/Compact License required
  • Minimum 2 years of Utilization Review experience within a hospital or health system (provider-side required)
  • Payer/insurance-only Utilization Management experience is not eligible
  • Minimum 3 years of acute care/hospital RN experience
  • Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
  • Experience applying InterQual and/or MCG criteria preferred
  • Excellent communication, analytical, and critical thinking skills
  • Ability to work independently in a remote environment
Responsibilities:
  • Conduct admission, concurrent/continued stay, and observation reviews
  • Apply medical necessity criteria to determine appropriate level of care
  • Escalate cases to Physician Advisors when appropriate
  • Collaborate with physicians, case managers, and insurance payers
  • Support denial prevention, documentation improvement, and revenue cycle initiatives
  • Ensure compliance with payer guidelines, CMS, and regulatory requirements
  • Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us

HealthPlus Staffing is a national leader in healthcare staffing. We partner with leading healthcare organizations nationwide to connect highly qualified professionals with exceptional career opportunities.

Our Promise
  • Direct access to hiring decision-makers
  • Timely feedback throughout the interview process
  • Dedicated support to help you make an informed career decision

If you're interested in this opportunity, please submit your application or call 561-291-7787 to speak with one of our experienced recruiters. We look forward to helping you find your next opportunity!

The HealthPlus Team