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Remote Utilization Review Rn Jobs in Missouri (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Saint Louis, MO · On-site +1

$52 - $63.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Springfield, MO · On-site +1

$48.25 - $58.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Americare

Regional Nurse Consultant (RN)

Saint Louis, MO · On-site +1

$85K - $100K/yr

Support resident-at-risk reviews, discharges, and transfers as needed Training & Support * Deliver ... Current Registered Nurse (RN) license required Experience & Knowledge * Five (5) years of long-term ...

Corvel

Care Advocate Nurse

Jefferson City, MO · Remote

$61.05K - $98.33K/yr

... ies), reviews medical data in CareMC, validates and secures medical information, assesses and ... This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Initiates and receives telephonic ...

DataAnnotation

Care Transition Nurse

California, MO · Remote

$50/hr

... Care & Utilization Management.BenefitsFull-time or part-time remote positionChoose which projects you want to work onFlexible scheduleProjects are paid hourly starting at $50+ per hourBonuses ...

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How much do remote utilization review rn jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote utilization review rn in Missouri is $39.66, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

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

Appeals Pharmacist (Remote)

Pharmacy Careers

Saint Louis, MO • On-site, Remote

$52 - $63.25/hr

Other

Posted 6 days ago

Job description

Appeals Pharmacist - Ensure Fair Medication Access for Patients
A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.
Key Responsibilities

  • Review clinical documentation for medication coverage appeals and grievances.
  • Apply evidence-based guidelines, plan policies, and regulatory requirements to determine outcomes.
  • Prepare written clinical rationales to support appeal determinations.
  • Collaborate with physicians, nurses, and medical directors during case reviews.
  • Track, document, and report appeal outcomes in compliance with state and federal regulations.
  • Support process improvements to enhance timeliness and quality of appeal decisions.


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 managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply.
  • Skills: Excellent clinical judgment, written communication, and attention to regulatory detail.


Why This Role?

  • Impact: Play a critical role in ensuring patients get fair access to necessary medications.
  • Growth: Gain expertise in appeals, utilization management, and managed care pharmacy.
  • Flexibility: Many roles offer hybrid or fully remote options.
  • Rewards: Competitive salary, comprehensive benefits, and opportunities for advancement.


About Us
We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.
Apply Today
Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.

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