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Remote Utilization Management Jobs in Raleigh, NC

Pharmacy Careers

Appeals Pharmacist (Remote)

Raleigh, NC · On-site +1

$51 - $62.25/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Deloitte

Epic Tapestry Consultant

Raleigh, NC · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work ...

Deloitte

Epic Tapestry Sr Analyst

Raleigh, NC · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Analytical/ Decision Making Responsibilities * Analytical ability to ...

Deloitte

Epic Tapestry Specialist

Raleigh, NC · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team

CVS Health

Case Manager, Registered Nurse

Raleigh, NC · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Raleigh, NC

Remote Utilization Management information

See Raleigh, NC salary details

$20

$41

$67

How much do remote utilization management jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote utilization management in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 as a Remote Utilization Management Nurse, and why are they important?

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

Remote Prior Authorization Pharmacist

Pharmacy Careers

Raleigh, NC • Remote

$52 - $62.50/hr

Other

Posted 16 days ago

Job description

Remote Prior Authorization Pharmacist - Work From Home in Managed Care
A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe and effective therapies. This work-from-home position is ideal for pharmacists who want to transition out of retail or hospital settings while building expertise in managed care.
Key Responsibilities

  • Review prior authorization requests for accuracy, appropriateness, and clinical necessity.
  • Apply plan criteria, evidence-based guidelines, and regulatory standards to determinations.
  • Communicate approval/denial decisions clearly to providers and patients.
  • Collaborate with physicians, nurses, and medical directors on complex cases.
  • Document outcomes in compliance with health plan policies and CMS/state regulations.
  • Support process improvements to streamline workflow and turnaround times.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply.
  • Skills: Excellent clinical review, documentation, and communication skills.

Why This Role?

  • Flexibility: 100% remote work from home with flexible scheduling options.
  • Impact: Directly influence patient access to safe and cost-effective medications.
  • Growth: Build specialized skills in utilization management and managed care.
  • Rewards: Competitive compensation, benefits, and career advancement opportunities.


About Us
We are a confidential healthcare partner working with health plans and PBMs across the U.S.. Our pharmacists ensure patients receive the right therapy at the right time while maintaining compliance with all regulations.
Apply Today
Take the next step in your career with our Remote Prior Authorization Pharmacist opportunity - and enjoy the benefits of working from home while shaping the future of managed care.

Apply