Remote Utilization Review Rn Jobs in Pomona, CA (NOW HIRING)

This is a fully remote position. Preferred candidates possess telehealth/remote patient support experience.

The Clinical Navigator provides individualized clinical education, treatment-support services, and care coordination within the scope of assigned patient-support programs. The role helps patients and caregivers understand prescribed treatment plans, identify potential barriers to treatment initiation and continuation, and develop practical strategies that support informed participation and adherence.
The Clinical Navigator conducts structured outreach throughout the patient journey, provides program-approved education, documents patient interactions and outcomes, and coordinates with authorized members of the patient's healthcare and support teams. The Clinical Navigator recognizes and escalates clinical, safety, access, psychosocial, and operational concerns in accordance with established program protocols and collaborates closely with case management and other cross-functional teams.
The Clinical Navigator does not diagnose, prescribe, modify treatment plans, provide emergency care, or replace the patient's treating healthcare team.

• Conduct structured outreach to patients and caregivers at designated points throughout the treatment journey.
• Provide accurate, program-approved education regarding prescribed treatment, preparation, administration logistics, adherence expectations, and available support resources.
• Identify patient- and caregiver-reported barriers to treatment initiation, continuation, or adherence and develop practical strategies within program scope.
• Identify clinical, educational, logistical, psychosocial, or access-related barriers that may contribute to missed treatment or nonadherence.
• Provide support within scope and route issues requiring clinical decision-making, access assistance, or additional services to the appropriate provider or internal team.
• Recognize and escalate urgent or potentially serious clinical concerns according to program protocols.
• Identify and report adverse events, product complaints, medication errors, missed or delayed treatment, treatment discontinuation, and other reportable information within required timelines.
• Escalate questions involving diagnosis, treatment selection, dosing, treatment modification, contraindications, or other clinical decisions to the treating healthcare provider.
• Coordinate communication and follow-up across authorized stakeholders in accordance with privacy standards and program workflows.
• Accurately document outreach attempts, education provided, patient concerns, milestones, outcomes, escalations, and follow-up activities.
• Manage an assigned caseload while meeting established quality and productivity standards.
• Maintain current knowledge of assigned products, disease states, treatment journeys, program resources, and approved educational materials.
• Communicate recurring patient, access, treatment, and operational trends to leadership and participate in quality improvement activities.

• Strong communication, active listening, motivational interviewing, and relationship-building skills.
• Excellent documentation, organization, prioritization, time management, and follow-up skills.
• Strong critical thinking, problem-solving, analytical, and independent judgment.
• Ability to manage multiple active cases, follow standardized protocols, and work independently in a remote environment.
• Ability to support patients and caregivers across multiple stages of the treatment journey.
• Ability to establish trust through respectful, collaborative, and nonjudgmental communication.
• Proficiency with case management or CRM platforms, electronic health records, Microsoft Office, secure messaging, video communication, and related healthcare technology.
• Working knowledge of patient privacy, adverse event reporting, product complaint reporting, professional boundaries, and scope-of-practice requirements.

• Bachelor's degree in a healthcare-related field preferred, or an equivalent combination of relevant education and clinical experience.
• Current, unrestricted professional license or certification applicable to the assigned program (e.g., LPN/LVN, RN, NP, PA, SLP, OT/COTA, PT/PTA, PharmD, Registered Dietitian).
• 2+ years of relevant experience in direct patient care, patient education, clinical navigation, care coordination, case management, specialty pharmacy, rehabilitation, infusion services, or patient-support programs preferred.
• Experience providing patient education and support through telephone, video, secure messaging, or other remote channels preferred.

• Remote work environment from the employee's approved home office.
• Prolonged periods of sitting and computer use.
• Ability to lift up to 15 pounds occasionally.
• Flexibility to support activities across U.S. time zones (EST–PST).
• Occasional travel for training, company meetings, or client activities.

At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other's joys in personal life and professional accomplishments, promoting meaningful relationships and friendships.

Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support.

We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work.

PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws.

At PRO-spectus, we are deeply committed to pay transparency and equity. The salary range for this position is $50.00 - $57.00 per hour based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance.

Our benefits include robust medical, dental, and vision plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, PRO-spectus prioritizes your financial and personal security. Plus, you may be eligible for a performance-based bonus opportunity.

Join PRO-spectus, where your career growth, well-being, and contributions truly matter!