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Remote Utilization Review Rn Jobs in Pittsburgh, PA

POCKET NURSE

Digital Media Coordinator

Monaca, PA · On-site +1

... Nurse provides solutions and services that create hands-on learning experiences for the next ... Paid time off, personal time, paid holidays, and flexible hybrid onsite/remote work schedules.

Varsity Tutors

NCLEX-PN Tutor

Pittsburgh, PA · Remote

$18 - $40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

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Remote Utilization Review Rn information

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$20

$41

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

As of Aug 17, 2026, the average hourly pay for remote utilization review rn in Pittsburgh, PA is $41.05, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.16 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 Pittsburgh, PA?

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

What job categories do people searching Remote Utilization Review Rn jobs in Pittsburgh, PA look for?

The top searched job categories for Remote Utilization Review Rn jobs in Pittsburgh, PA are:

What cities near Pittsburgh, PA are hiring for Remote Utilization Review Rn jobs?

Cities near Pittsburgh, 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 Pittsburgh, PA as of August 2026, with employment types broken down into 40% Full Time, and 60% Part Time. Highlights an 100% Remote job distribution, with an average salary of $85,380 per year, or $41 per hour.

Senior Clinical Pharmacy Specialist (Remote)- Must be licensed in PA!

UPMC Senior Communities

Pittsburgh, PA • On-site, Remote

$51.48 - $87.36/hr

Full-time

Re-posted 13 days ago

Job description

UPMC Health Plan has an exciting opportunity for a Senior Clinical Pharmacy Specialist in the Pharmacy Services department. This is a remote position working Monday through Friday daylight hours.
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required.
The Senior Clinical Pharmacist must demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed. In addition to consistent, exceptional performance, the Senior Pharmacist must have already demonstrated their initiative and ability to work independently. This role will have completed several stretch projects as outlined by their manager. The stretch projects, in addition to all new projects, would then be the ongoing responsibility of the Senior Pharmacist to manage. This may include but is not limited to, training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives. Additionally, the Senior Clinical Pharmacist will assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs. This role is responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks.
Responsibilities:
  • The Senior Clinical Pharmacist must demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed. In addition to consistent, exceptional performance, the Senior Pharmacist must have already demonstrated their initiative and ability to work independently. This role will have completed several stretch projects as outlined by their manager. The stretch projects, in addition to all new projects, would then be the ongoing responsibility of the Senior Pharmacist to manage. This may include but is not limited to, training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives. Additionally, the Senior Clinical Pharmacist will assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs. This role is responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks.
  • The Product Development Pharmacist is responsible for: Assisting with clinical management of the designated line of business (Commercial, Exchange, Medicare, Medicaid, Exchange, and/or CHIP) from a pharmacy formulary and operational perspective and for understanding and complying with rules and regulations affecting the business. Develop and revise various formularies for each line of business including sending communications, training of identified departments, updating all brochures, updating appropriate websites, and submitting change forms. Review new drugs promptly and submit change forms as appropriate. Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts. Present these assignments succinctly and at a suitable pace and answer relevant questions.
  • Provide innovative ideas for new and existing clinical program development, utilization management, formulary management, provider education, and therapeutic substitution programs. Work with employer clients, account management, and sales in meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations.

Additional responsibilities for the Sr Pharmacist include:
  • Administrative Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS, and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions. Communication Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers. Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management.
  • Teaching and Education Mentor students and assist in precepting for the residency program if applicable. Assists in the training of pharmacy personnel.
  • Special Skills/Ability to Interact: Have the ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness in completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers, and clients. Honor client and patient confidentiality.

Qualifications - Internal
Qualifications:
  • Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
  • Experience in pharmacy benefit management, insurance, managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs.
  • One year of experience in a managed care pharmacy setting.
  • Effective communication skills, both written and oral.
  • Must have strong analytical ability and organizational skills.
  • Computer literacy for pharmacy programming, word processing, data management.
  • Assessment of job-related skills and competency will be reviewed annually via daily functioning, job-related documentation, department-based competency programs, and continuing education activities.
    Licensure, Certifications, and Clearances:
    Registration as a registered pharmacist (RPh), in home state. Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board.
  • Pharmacist
  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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