Remote Utilization Review Rn Jobs in Monaca, PA (NOW HIRING)

This is a remote, work-from-home position in Pennsylvania offering an overnight schedule.

Essential Functions
Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.
1. Accurately perform prescription data entry in accordance with company policies, IPU standards, and regulatory requirements, ensuring timely and precise updates to patient records.
2. Demonstrate proficiency with pharmacy systems and Microsoft-based applications - including Docuware, Outlook, Excel, Word, Teams, Zetafax, and Infinity, using these tools to support prescription management and communication.
3. Review and process faxed medication orders, efficiently verifying and clarifying information with hospices as needed, and thoroughly documenting all interactions.
4. Maintain in-depth knowledge of brand and generic drug names, formulary guidelines, and IPU-specific medication profiling standards to ensure accuracy in MARs and patient profiles.
5. Perform daily activities while meeting established IPU goals, maintaining profile accuracy, call quality, and compliance with all operational standards.
6. Provide support for Automated Dispensing System (ADS) troubleshooting and after-hours protocols, including customer service, E3 support, Vitas E3 support, and PCO-related urgent processing.
7. Maintain detailed call logs and documentation for every client, prescriber, and hospice interaction, ensuring accountability and traceability.
8. Assist local pharmacies with adjudication of claims for emergent medications, escalating urgent requests appropriately and following compliance requirements.
9. Support compliance initiatives and ADS-related reporting, tracking, and trending activities to ensure adherence to internal policies and regulatory standards.
10. Collaborate with internal and external stakeholders to resolve prescription-related issues and continuously improve IPU processes.

Marginal or Additional Functions

1. Perform other duties as assigned, demonstrating flexibility and the ability to prioritize tasks to meet organizational needs.

Supervisory and Managerial Responsibility

• This position does not include supervisory or managerial responsibilities.

Knowledge, Skills & Abilities

Education, Licensure or Certification:

• High school diploma or equivalent
• CPhT preferred
• Pharmacy Technicians residing in Pennsylvania must be registered with PA Board of Pharmacy or obtain registration prior to internal deadline.
• Pharmacy Technicians residing in Tennessee must be registered with TN Board of Pharmacy
Work Experience or Related Experience

• One (1) year of pharmacy technician data entry experience (2 years preferred)
• Has good knowledge of brand and generic drug names
• Familiarity with drug formularies

Specialized Knowledge, Skills & Abilities

• Ability to work independently and accurately in a fast-paced environment
• Must be able to comprehend documents received via fax
• Excellent communication skills, both verbally and in writing
• Ability to manage multiple priorities efficiently with attention to detail
• Excellent problem-solving and critical thinking skills
• Ability to oversee workflow effectively in remote sites
• Accurate and efficient typing/data-entry skills
• Proficiency with pharmacy-based systems for prescription data entry, Windows-based applications, and Microsoft Office Suite
• Self-motivated with a strong work ethic and professional integrity

Travel Requirements and Conditions

• No travel is required.

Work Environment, Conditions and Demands

• Must have the ability to provide a high-speed DSL or cable internet connection for a home office.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information is required.
• Schedule flexibility in work hours is required.

Physical Requirements and Demands
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.

• May sit, stand, stoop, bend, and walk intermittently during the work shift.
• May sit or stand seven (7) to ten (10) hours per shift. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required.
• May need to lift up to twenty-five (25) pounds on occasion.
• Visual acuity to see and read fine prints. Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus.
• Must be able to hear normal sounds.

Additional Position Information

• No additional information is applicable.