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Remote Utilization Management Jobs in West Virginia

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Novolex

$89K - $115K/yr

... management and utilization, managing national agreements, and market share expansion. The ideal ... Remote Company BenefitsWhat You'll Get From UsBenefits With safety as our top priority and a ...

Novolex

$89K - $115K/yr

... management and utilization, managing national agreements, and market share expansion. The ideal ... Remote Company BenefitsWhat You'll Get From UsBenefits With safety as our top priority and a ...

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

AmeriSave Mortgage Corp.

$60K - $120K/yr

We offer advanced technology and support roles that enable our processors to easily manage larger ... Utilization of AUSSIE and company procedures * Establish an ongoing relationship by delivering best ...

Anatolia

Utilization of all available channels such as e-commerce sites and store locations * Partnering ... Support the development and management of major customer accounts * Coordinate sales operations ...

GDIT

Healthcare Finance Lead

WV · Remote

$85K - $109K/yr

Data Reporting, Financial Data, Financial Management, Financial Operations Certifications: None ... Remote Work Location: Any Location / Remote Additional Work Locations: Total Rewards at GDIT: Our ...

Corvel

Telephonic Case Manager I

Charleston, WV · Remote

$63K - $95K/yr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Provide medical case management to ... Strong cost containment background, such as utilization review or managed care helpful

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in West Virginia

Remote Utilization Management information

See West Virginia salary details

$16

$32

$53

How much do remote utilization management jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for remote utilization management in West Virginia is $32.73, according to ZipRecruiter salary data. Most workers in this role earn between $25.87 and $37.60 per hour, depending on experience, location, and employer.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in West Virginia? The most popular types of Utilization Management jobs in West Virginia are:
What are popular job titles related to Remote Utilization Management jobs in West Virginia? For Remote Utilization Management jobs in West Virginia, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in West Virginia look for? The top searched job categories for Remote Utilization Management jobs in West Virginia are:
What cities in West Virginia are hiring for Remote Utilization Management jobs? Cities in West Virginia with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in West Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $68,085 per year, or $32.7 per hour.

Director, Trade Client Relations

Bcbsa

Remote

$155K - $175K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Job description

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans. The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies to comply with manufacturer contracts, implements Trade strategies and initiatives, and collaborates with and supports Synergie's Client Relations team for Trade related inquiries. This includes medical and pharmacy drug policies, cross benefit management, and rebate qualification for manufacturer contracts. This position will establish and maintain cross functional partnerships with internal teams to drive the identification, development and successful execution of Synergie's rebate programs. This position will be the primary Trade point of contact for Synergie's Participant facing activities and will support clinical decision making at the Participant level to comply with manufacturer contracts.

Primary Job Functions

  • Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants

  • Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies

  • Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation

  • Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria

  • Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance

  • Collaborate and support Client Relations team for Trade related inquiries from Participants

Partner with the following stakeholders:

  • Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies

  • Client Relations - Serve as Trade's primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade's leadership

  • Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

  • Invoicing Team - Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies

  • Product Team - Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs

Education, Experience, and Certification

  • Pharmacy degree and Pharm D. preferred

  • 5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

  • Excellent verbal and written presentation skills

  • Ability to establish rapport and build relationships at all levels within an organization

  • Practical application of clinical data to drive financial value

  • Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint

Knowledge, Skills, and Abilities

  • Pharmacy residency training or equivalent experience

  • Experience within the PBM industry, Medicaid, Medicare, and health plans

  • Experience with contract language and risk mitigation concepts

Travel Requirements: Up to 10% of the time.

Work is generally performed in a remote setting.

#LI-Remote

$155,000.00 - $175,000.00

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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