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Remote Utilization Review Rn Jobs in Philadelphia, PA

HHS LLC

Registered Dietitian

Wilmington, DE · On-site +1

$30.25 - $40.75/hr

Hybrid-Remote schedule available! Opportunity to work across a diverse group of settings, from ... Review and approve patients'/residents' daily menu, snack, and supplement programs * Communicate ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Philadelphia, PA

Remote Utilization Review Rn information

See Philadelphia, PA salary details

$21

$42

$69

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

As of Aug 8, 2026, the average hourly pay for remote utilization review rn in Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 per hour, depending on experience, location, and employer.

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 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 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 are the most commonly searched types of Utilization Review Rn jobs in Philadelphia, PA? The most popular types of Utilization Review Rn jobs in Philadelphia, PA are:
What are popular job titles related to Remote Utilization Review Rn jobs in Philadelphia, PA? For Remote Utilization Review Rn jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Philadelphia, PA look for? The top searched job categories for Remote Utilization Review Rn jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Remote Utilization Review Rn jobs? Cities near Philadelphia, PA 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 Philadelphia, PA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

Clinical Consulting Pharmacist - Remote (must reside in PA or TN)

StateServ

Philadelphia, PA • On-site, Remote

$55.28 - $57.69/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 20 days ago

Job description

Dragonfly Health - A great place to land
Dragonfly Health is the leading care-at-home data, technology and service platform, and the industry's first scale durable medical equipment (DME) and pharmacy solution. Built on a 20-year history, Dragonfly Health uses advanced technology and robust analytics to manage DME and pharmaceutical services as part of a single, efficient solution for caregivers, patients, and their families. We serve over 145,000 patients every day in all 50 states.
Here, you are an integral part of a team that is transforming the future of hospice and post-acute healthcare. This is where innovation, collaboration and compassion thrive, allowing us to carry out our work at the highest level to serve our patients at a time in their life when they need us most.
We offer a dynamic and inclusive workplace where you'll have the unique opportunity to shape the future of healthcare alongside a passionate and talented team. We believe in empowering our employees to grow both personally and professionally, providing ample opportunities for career advancement, continuous learning, and skill development.
Dragonfly Health is our name for a reason.
The dragonfly is symbolic of the transformational impact we're making on the industry, our people, and the lives we touch. We are a guiding force for what's ahead, delivering more than equipment and medications, but also comfort and peace of mind. We are agile and adaptable, able to quickly and easily pivot from one point to the next, ready for whatever situation or patient need that arises.
Whatever it takes. Wherever it takes us.
What we offer
  • Competitive Pay $55.28-57.69/hour + $5,000 sign-on bonus with shift differential (12% 6PM to 12:00AM and 15% 12:01AM-6AM)
  • Comprehensive Benefits Package (Health, Dental, Vision, PTO, Sick Time, 401k w/match, etc.)
  • Growth Opportunity and Career Advancement
  • Agile and Adaptable team culture
  • Innovative and revolutionary technology solutions
  • A higher calling to provide quality patient care

See how Dragonfly Health is transforming the world of hospice and post-acute care.
What you will do
  • Provide clinical review and consultation on medication requests, prior authorizations, and benefit determinations.
  • Evaluate therapy appropriateness, dosing, and safety based on evidence-based guidelines.
  • Collaborate with providers to clarify prescriptions and recommend alternatives when appropriate.
  • Support complex case reviews and appeals with accurate clinical documentation.
  • Identify opportunities to improve medication adherence, safety, and cost-effectiveness.
  • Educate internal teams on formulary management, utilization review, and pharmacy policy updates.
What we look for
  • R.Ph required; PharmD preferred
  • Full, current, and unrestricted pharmacist license in PA, TN
  • Ability to obtain additional state licensure based on business needs
  • 1+ year of pharmacy experience preferred (retail, hospital, or managed care)
  • Working knowledge of formulary management, clinical guidelines, and pharmacy benefit structures
  • Strong communication, analytical, and consultative skills
  • Ability to exercise sound clinical judgment and work independently
  • Commitment to evidence-based practice and continuous learning
Why Clinical Consulting Pharmacists are important
Every medication decision we make affects someone's health, safety, and quality of life. As a Clinical Consulting Pharmacist, you ensure our members receive clinically appropriate, cost-effective therapies - helping balance patient care with responsible resource management. Your expertise directly advances our mission of improving health outcomes through compassionate, evidence-based pharmacy care.
Let's soar together
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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