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Remote Utilization Management Jobs in Worcester, MA

RPh on the Go

Pharmacist in Leominster, MA

Leominster, MA · On-site +1

$55 - $65/hr

A remote Pharmacist opportunity is available on a temp-to-hire basis, offering the chance to contribute your expertise in utilization management within a dynamic healthcare environment. This role is ...

RPh on the Go

Pharmacist in Framingham, MA

Framingham, MA · Remote

$55 - $65/hr

Prior utilization management and prior authorization experience is a significant advantage This is a demanding yet rewarding role for pharmacists seeking to apply their expertise in a remote, fast ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Worcester, MA

Remote Utilization Management information

See Worcester, MA salary details

$21

$42

$68

How much do remote utilization management jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote utilization management in Worcester, MA is $42.19, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.46 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 Worcester, MA?

For Remote Utilization Management jobs in Worcester, MA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Worcester, MA look for?

The top searched job categories for Remote Utilization Management jobs in Worcester, MA are:

What cities near Worcester, MA are hiring for Remote Utilization Management jobs?

Cities near Worcester, MA with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Worcester, MA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $87,755 per year, or $42.2 per hour.

Pharmacist - Waltham, Massachusetts

RPh on the Go

Waltham, MA • Remote

$55 - $65/hr

Contractor

Medical

This job post has expired today. Applications are no longer accepted.

Job description

A remote Pharmacist opportunity is available with a leading healthcare provider, offering a contract-to-hire position. This role requires a dedicated professional with strong clinical judgment and experience in utilization management, focusing on Part B drug and biologic prior authorization requests and appeals.

Location: Remote (open to licensed pharmacists from any state)
Schedule: Monday–Friday, 12:00 PM–8:30 PM EST
Weekend & Holiday Rotation: Mandatory (no days off except emergencies from 01/01/27 to 03/31/27)
Contract Duration: 10/01/26 to 03/31/27 (6 months)

Key Responsibilities:

  • Review and evaluate Part B drug and biologic prior authorization requests and appeals according to clinical policies and Medicare requirements.
  • Apply utilization management criteria to ensure appropriate authorization decisions.
  • Provide support to internal clinical and non-clinical teams regarding Part B drug policies and workflows.
  • Identify and recommend improvements for review quality, accuracy, and operational efficiency.
  • Adapt to a fast-paced environment with changing workflows, processes, and business needs.
  • Consistently maintain high quality and productivity while managing shifting priorities and workload volumes.

Required Qualifications:

  • PharmD degree and an active pharmacist license in at least one state.
  • Minimum of 2 years of utilization management experience, managed care residency, or applicable specialty pharmacy background.
  • Strong clinical judgment with the ability to independently assess complex Part B drug requests.
  • Familiarity with Part B drug prior authorization and appeals processes.
  • Prior utilization management and prior authorization experience strongly preferred.

This position offers the opportunity to contribute to impactful clinical decisions within a remote setting. If you meet these qualifications and are ready for a challenging role that values clinical expertise, apply today to take the next step in your pharmacy career.

Compensation for this position ranges from $55.00 to $65.00. Eligible candidates may also receive healthcare benefits, housing, and meals/incidentals. Full details of our healthcare benefits plan can be found here. This posting is open for 60 days after the posting date.

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About RPh on the Go

Sourced by ZipRecruiter

At RPh on the Go, we’re all about pharmacists. As a company started by pharmacists for pharmacists, we understand the extraordinary responsibilities you take on every day, the tremendous demands placed on you and your colleagues, and the rewards that come with working in one of the country’s most highly respected professions.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Chicago, IL, US

Year founded

1980

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