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Remote Utilization Management Pharmacist Jobs in Kentucky

Lifepoint Health

Claims Analyst- Remote

Louisville, KY · On-site +1

Days: M-F Job Location Type: [ Remote] Your experience matters At Lifepoint Health, we are ... Collaborate with Utilization Management departments to ensure pre-certifications, authorizations ...

Lifepoint Health

Claims Analyst- Remote

Louisville, KY · Remote

Days: M-F Job Location Type: [ Remote] Your experience matters At Lifepoint Health, we are ... Collaborate with Utilization Management departments to ensure pre-certifications, authorizations ...

New

Amerita

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

... receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy ... Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer ...

Amerita

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

... receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy ... Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

... receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy ... Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

... receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy ... Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

... receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy ... Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer ...

Valeris

Executive Case Manager (Remote)

Pikeville, KY · Remote

... management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and ... Remote work eligibility is subject to all work from home criteria met and based on business need ...

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Remote Utilization Management Pharmacist information

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.

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 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 popular job titles related to Remote Utilization Management Pharmacist jobs in Kentucky?

For Remote Utilization Management Pharmacist jobs in Kentucky, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management Pharmacist jobs in Kentucky look for?

The top searched job categories for Remote Utilization Management Pharmacist jobs in Kentucky are:

What cities in Kentucky are hiring for Remote Utilization Management Pharmacist jobs?

Cities in Kentucky with the most Remote Utilization Management Pharmacist job openings:

Remote Utilization Management Pharmacist jobs near you
Infographic showing various Remote Utilization Management Pharmacist job openings in Kentucky as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Claims Analyst- Remote

Louisville, KY • On-site, Remote

Lifepoint Health
Health Care and Social Assistance • 10K+ employees

5.9

Company rating: 5.9 out of 10

Based on 272 frontline employees who took The Breakroom Quiz

767th of 896 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about Lifepoint Healthexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Job description


Schedule: Days: M-F
Job Location Type: [ Remote]
Your experience matters
At Lifepoint Health, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. As a member of Springstone Behavioral Health team, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier ®.
More about our team
The Claims Analyst is responsible for managing billing and collections across multiple facilities, ensuring compliance with payor requirements, and maintaining accurate accounts receivable. This role also supports staff follows financial processes, and collaborates with internal departments to ensure timely and accurate reimbursement activities.
How you'll contribute
A Claims Analyst who excels in this role:
  • Accurately performs billing and collections for multiple facilities for all payors.
  • Provide professional and technical support to staff across multiple departments.
  • Respond to inquiries from insurance carriers, patients, and family members regarding billing and account balance questions.
  • Monitor and review financial systems to ensure accurate revenue recognition and maintain appropriate accounts receivable levels aligned with payer mix and acuity.
  • Collaborate with Utilization Management departments to ensure pre-certifications, authorizations, and appeals are completed accurately and on time.
  • Perform effective and timely follow-up on insurance claims to secure appropriate reimbursement.
  • Analyze explanations of benefits (EOBs), remittances, and explanations of payment (EOPs) to identify discrepancies or underpayments.
  • Research and resolve claim issues
  • Prepare, submit, and track appeals for denied claims through resolution.
  • Prepare for and actively participate in weekly Accounts Receivable (AR) meetings.

Why join us
We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:
  • Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
  • Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
  • Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
  • Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
  • Professional Development: Ongoing learning and career advancement opportunities.

What we're looking for
Applicants should have a high school diploma required; Associate degree preferred with 3-5 years of computerized medical billing experience required with behavioral healthcare experience preferred and working knowledge of Medicare/Medicaid and institutional billing requirements.
Additional requirements include:
  • Strong knowledge of Medicare/Medicaid guidelines and UB04 billing requirements
  • Proficiency in computerized medical billing systems
  • Ability to manage multiple facilities and payor types simultaneously
  • Strong analytical and problem-solving skills
  • Effective communication with internal teams and external stakeholders
  • Detail-oriented with strong organizational skills
  • Ability to work in a fast-paced, high-volume, production-based environment
  • Understanding of Hospital Revenue Cycle processes within a multi-facility healthcare environment

EEOC Statement
"Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."
You must be authorized to work in the United States without employer sponsorship.
About Us
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
About the Team
We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
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About LifePoint Health

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Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

Social media

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Pay

Benefits

Hours and flexibility

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