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Remote Utilization Management Pharmacist Jobs in Virginia

Sentara Healthcare

Cybersecurity Analyst - Remote

Norfolk, VA · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... for optimal utilization of applications. Develops system test plans and performs testing of ... Responsible for problem, incident, and change management and service requests. Provides daily ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, or managed care experience; or any combination of education and experience ... Prefer candidates who hold an active compact license and reside in a compact state * 100% Remote ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, or managed care experience; or any combination of education and experience ... Prefer candidates who hold an active compact license and reside in a compact state * 100% Remote ...

FCCI Insurance Group

Medical Case Manager

Glen Allen, VA · On-site +1

$62K - $96K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are seeking a licensed Registered Nurse to provide telephonic case management on assigned ... s) through utilization of established guidelines to determine appropriate medical treatment ...

Sentara Healthcare

Integrated Case Manager- RN

Fredericksburg, VA · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... efficient utilization of health benefits; conducts gap in care management for quality programs ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Sentara Healthcare

Integrated Case Manager- RN

Winchester, VA · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Day (8am-5pm) ThisPosition is remote but does require in person face-to-face assessments ... efficient utilization of health benefits; conducts gap in care management for quality programs.

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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 Virginia?

The most popular types of Utilization Management Pharmacist jobs in Virginia are:

What are popular job titles related to Remote Utilization Management Pharmacist jobs in Virginia?

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

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

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

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

Cities in Virginia 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 Virginia as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Remote Collaborative Practice Nurse RN Sr

The US Oncology Network

Roanoke, VA • On-site, Remote

Full-time

Re-posted 14 days ago

US Oncology rating

7.1

Company rating: 7.1 out of 10

Based on 109 frontline employees who took The Breakroom Quiz

380th of 887 rated healthcare providers

Job description

Overview
Blue Ridge Cancer Care is seeking an experienced and highly motivated Collaborative Practice Nurse (CPN) to support oncology patients across the continuum of care. The CPN serves as a clinical resource and care coordinator, partnering closely with providers, nursing teams, and interdisciplinary staff to improve patient outcomes, enhance the patient experience, and support value-based care initiatives.
This role focuses on proactive patient management, care coordination, symptom assessment, patient education, and navigation of complex clinical needs. The ideal candidate is a strong communicator, critical thinker, and patient advocate who thrives in a collaborative environment and is passionate about delivering high-quality oncology care.
Work Location Options
This position offers flexibility to meet both organizational and employee needs:
Fully Remote: Candidates may work remotely from anywhere within the United States.
Hybrid: Candidates who prefer a combination of remote and on-site work may choose a hybrid schedule based on business needs and location.
Responsibilities
Respond promptly to patient inquiries via calls, portal messages, and emails, ensuring timely communication and intervention.
  • Utilize open-ended questions and computerized algorithms/pathways to assess and manage a wide range of patient symptoms and side effects, documenting all interventions thoroughly to maintain comprehensive medical records.
  • Determine the urgency of patient symptoms/side effects, aggressively managing them to prevent unnecessary emergency department and hospital utilization.
  • Collaborate with physicians through electronic communication, face-to-face meetings, or phone calls for cases requiring emergency care that cannot be addressed independently through standard protocols.
  • Coordinate with providers to facilitate outpatient clinic visits for patients when appropriate, ensuring continuity of care.
  • Prepare, organize, and lead Patient Care Conferences (huddles), communicating interventional outcomes to the full care team efficiently.
  • Perform assessments for patient risk stratification, basic psychosocial assessments, and provide emotional support, delegating or making referrals for further screening and support as needed.
  • Develop and implement nursing diagnoses and corresponding action plans, supporting oral chemotherapy education, adherence, and side effect monitoring.
  • Engage in survivorship and advance care planning visits, making necessary referrals to support patient needs.
  • Participate in research, quality, and performance improvement initiatives, including reporting on navigation metrics, while supporting patient advocacy and empowerment.
  • Serve as a mentor/preceptor, providing guidance to less experienced nurses and performing other duties as required.
  • Identify potential and real gaps in care delivery, seeking opportunities to address and close these gaps.
  • Stay informed on practice operations guidelines, healthcare economics, value-based care, and quality programs, with travel to outlying clinics as needed based on care team requests.

Qualifications
  • Bachelor's prepared Registered Nurse (BSN) preferred, Oncology Certification (OCN) a plus, Nurse Navigator Certification a plus
  • 5 (five) years work experience as a Registered Nurse. Oncology experience preferred.

Critical Skills:
  • Demonstrated leadership, interpersonal, collaboration, communication, and active listening skills
  • Ability to apply the full nursing process in day-to-day clinical operations, including assessment, analysis and nursing diagnosis, care planning, implementation and outcomes evaluation
  • Ability to assess health disparities, identify needs of populations and cultures found within the general facility service area, describe a patient navigation process to address those needs, and document outcomes
  • Highly adaptable due to shifting priorities around value-based care/quality program requirements; ability to prioritize and re-prioritize quickly
  • Strong organizational, critical thinking, and follow-through skills
  • Ability to apply and/or oversee care coordination in conjunction with the multidisciplinary team
  • Strong verbal and written communication skills
  • Ability to problem-solving cross-functionally or independently, and know when to pull in leaders or other care team members to come up with a solution
  • Thrives in a team environment; embraces teamwork, but also enjoys and is successful at working independently

Additional Knowledge/Skills
  • Working computer, Microsoft, and internet skills, including an electronic EMR system
  • Basic knowledge of local community resources

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
-Required to lift and assist patients as requested.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment may occur.
Salary Scale: The general pay scale for this position at BRCC is $62,933.07 - $96,824.00. The actual hiring rate is dependent on many factors, including but not limited to prior work experience, education, job/position responsibilities, location, work performance, etc.

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