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Remote Utilization Review Rn Jobs in West Virginia

Bcbsa

$155K - $175K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Insulet Corporation

$79K - $118K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... Nurse (RN) * State licensure is mandatory as required * Current Certified Diabetes Care and ... This position is a remote working position, and the working space will have to meet certain ...

61st Street Service Corp

$23.56 - $28.85/hr

  • Medical

  • PTO

... nurses, offering more than 240 specialties and subspecialties. This position is primarily remote ... Review account history for continuous follow up. * Address incoming correspondence. Prepare ...

61st Street Service Corp

$23.56 - $28.85/hr

  • Medical

  • PTO

... nurses, offering more than 240 specialties and subspecialties. This position is primarily remote ... Review account history for continuous follow up. * Address incoming correspondence. Prepare ...

GDIT

Cloud Program Cost FinOps Analyst (AWS)

WV · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Low Utilization of Cloud Resources * Assists with the management of various master payer account(s ... Location :100% remote working; required to be onsite once a year, as requested * Security Clearance ...

Novolex

$89K - $115K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Conduct business reviews and develop growth strategies to expand product adoption, category ... Remote Company BenefitsWhat You'll Get From UsBenefits With safety as our top priority and a ...

Novolex

$89K - $115K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Conduct business reviews and develop growth strategies to expand product adoption, category ... Remote Company BenefitsWhat You'll Get From UsBenefits With safety as our top priority and a ...

GDIT

Healthcare Finance Lead

WV · On-site +1

$85K - $109K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization trends. * Oversee medical and pharmacy payments while reviewing underlying claims ... Remote Work Location: Any Location / Remote Additional Work Locations: Total Rewards at GDIT: Our ...

RELX

Senior Director Sales Enablement

Charleston, WV · Remote

Senior Director, Sales Enablement (Remote-US) About our Team Clinical Solutions is a technology ... Nursing, Patient Engagement and Precision Medicine. Our products aim to optimize care delivery ...

Centene

$107K - $199K/yr

  • Medical

  • Retirement

  • PTO

Develop and present performance reviews in tandem with provider facing teams to address pharmacy ... This is a remote role with travel of 50% or more to provider offices and community pharmacies.

OneOncology

Medical Coding Specialist

Charleston, WV · Remote

The Medical Coding Specialist may also be assigned to audit physician, nurse practitioner and ... Performs E&M and CPT coding review and other projects related to physician coding compliance in ...

OneOncology

Medical Coding Specialist

Charleston, WV · Remote

The Medical Coding Specialist, under general supervision, performs daily charge review of visits ... The Medical Coding Specialist may also be assigned to audit physician, nurse practitioner and ...

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Showing results 21-40

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in West Virginia

Remote Utilization Review Rn information

See West Virginia salary details

$16

$32

$53

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

As of Aug 18, 2026, the average hourly pay for remote utilization review rn 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.

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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 West Virginia?

For Remote Utilization Review Rn jobs in West Virginia, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in West Virginia look for?

The top searched job categories for Remote Utilization Review Rn jobs in West Virginia are:

What cities in West Virginia are hiring for Remote Utilization Review Rn jobs?

Cities in West Virginia with the most Remote Utilization Review Rn job openings:

Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in West Virginia as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $68,085 per year, or $32.7 per hour.

Director, Trade Client Relations

Bcbsa

On-site, Remote

$155K - $175K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 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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