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Remote Utilization Management Jobs in Gilbert, AZ

A-Line Staffing Solutions

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Remote Pharmacist - Prior Authorization / PBM Experience

Phoenix, AZ · Remote

$53 - $55/hr

Formulary management * Drug Utilization Review (DUR) * Strong understanding of CMS regulations and ... Remote Work Requirements Candidates must have: * A dedicated, quiet workspace free from ...

StateServ

Account Manager - Remote

Mesa, AZ · On-site +1

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

StateServ

Account Manager - Remote

Mesa, AZ · On-site +1

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

StateServ Medical LLC

Account Manager - Remote

Mesa, AZ · Remote

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

StateServ Medical

Account Manager - Remote

Mesa, AZ · Remote

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

StateServ Medical LLC

Account Manager - Remote

Mesa, AZ · Remote

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

StateServ Medical

Account Manager - Remote

Mesa, AZ · Remote

$65K - $75K/yr

... utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas, facilitating customer discussions, documenting action items, and ...

Lincare

Medical Nutrition Spc - Remote

Phoenix, AZ · Remote

$29.25 - $39.25/hr

Collaborates remotely with physicians, nurses, case managers, and other healthcare professionals ... for utilization in patient care applications * Verifies enteral and oral nutrition orders for ...

Gateway Recruiting

TM

Phoenix, AZ · Remote

... Remote monitoring workflow development, Utilization ramp and adoption metrics * Strong executive ... M platforms (Salesforce preferred), analytics, and Excel. * Willingness to travel 60-70% within ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Gilbert, AZ

Remote Utilization Management information

See Gilbert, AZ salary details

$21

$42

$68

How much do remote utilization management jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for remote utilization management in Gilbert, AZ is $42.15, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.41 per hour, depending on experience, location, and employer.

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 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.

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 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 popular job titles related to Remote Utilization Management jobs in Gilbert, AZ?

For Remote Utilization Management jobs in Gilbert, AZ, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Gilbert, AZ look for?

The top searched job categories for Remote Utilization Management jobs in Gilbert, AZ are:

What cities near Gilbert, AZ are hiring for Remote Utilization Management jobs?

Cities near Gilbert, AZ with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Gilbert, AZ as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $87,666 per year, or $42.1 per hour.

Remote Pharmacist - Prior Authorization / PBM Experience

A-Line Staffing Solutions

Phoenix, AZ • Remote

$53 - $55/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 11 days ago

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Job description

Pay: $53.00 per hour

Job description:

Remote Pharmacist – Prior Authorization / PBM Experience

Pay Rate: $53.00/hr

Start Dates

  • October 12th
  • October 26th

Training Requirements

  • Mandatory paid training is held Monday – Friday, 9:00 AM – 5:30 PM EST for approximately 8–10 weeks.
  • Attendance is mandatory during training. No planned vacation or scheduling conflicts are permitted during this period.
  • Candidates must be available for the entire training schedule before accepting the assignment.
  • Camera must remain on during all virtual training sessions, supervisor meetings, and team meetings.

Schedule

Business Hours:

  • Monday – Friday: 7:00 AM – 8:00 PM EST
  • Saturday & Sunday: 7:00 AM – 4:30 PM EST

Schedule Type: Set Rotation

After training, candidates will be assigned an 8-hour shift based on business needs, which will include either:

  • One weekend day each week, or
  • A rotating weekend schedule.

Job Summary

We are seeking a licensed Registered Pharmacist to support a high-volume, remote Prior Authorization and Coverage Determination team. This role is responsible for reviewing pharmacy benefit requests, interpreting clinical criteria, evaluating Medicare Part D coverage determinations, and ensuring accurate, timely decisions while maintaining compliance with regulatory requirements.

The ideal candidate has experience in Pharmacy Benefit Management (PBM), prior authorizations, managed care, or clinical pharmacy operations and thrives in a productivity-driven remote environment with strict turnaround times.

This is a Safety Sensitive position.

Key Responsibilities

  • Review and evaluate prior authorization and coverage determination requests.
  • Interpret Medicare Part D guidelines, formulary requirements, and clinical criteria.
  • Apply evidence-based clinical judgment using drug information resources and clinical compendia.
  • Ensure compliance with CMS regulations, plan policies, and pharmacy benefit guidelines.
  • Document case reviews accurately and maintain audit-ready records.
  • Manage a high-volume case queue while meeting quality and productivity standards.
  • Perform provider outreach as needed to obtain clinical information or clarify requests.
  • Navigate multiple applications simultaneously while documenting case activity.
  • Work independently in a fast-paced remote environment with minimal supervision.
  • Participate in virtual meetings, coaching sessions, and required training.

Required Qualifications

  • Active Registered Pharmacist (RPh) license in good standing in the state of residence.
  • Experience with:
  • Pharmacy Benefit Management (PBM)
  • Prior Authorizations
  • Coverage Determinations
  • Medicare Part D
  • Formulary management
  • Drug Utilization Review (DUR)
  • Strong understanding of CMS regulations and managed care pharmacy.
  • Excellent documentation and data entry skills.
  • Experience working in high-volume, productivity-driven environments.
  • Strong computer skills, including Microsoft Excel and Word.
  • Ability to navigate multiple computer applications using dual monitors.

Preferred Qualifications

  • Experience with provider outreach and clinical case review.
  • Retail pharmacy combined with managed care or PBM experience.
  • Knowledge of Microsoft Access, PowerPoint, and Visio.
  • Previous remote clinical review experience.

Remote Work Requirements

Candidates must have:

  • A dedicated, quiet workspace free from interruptions.
  • Wired high-speed internet with a minimum of:
  • 25 Mbps download
  • 5 Mbps upload
  • Dual-monitor capability.
  • Ability to remain seated and focused throughout the workday.

Additional Requirements

  • Virtual interviews are conducted through Microsoft Teams.
  • Candidates must be comfortable with extensive data entry, multitasking, and working independently while maintaining productivity standards.
  • Opportunity for full-time employment based on performance.

Benefits:

  • Dental insurance
  • Health insurance
  • Vision insurance
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About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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