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Remote Utilization Review Rn Jobs in Providence, RI

Manulife

Medical Director

Carolina, RI · Remote

$152K - $283K/yr

Health care professional in good standing (MD, DO, RN, PA, NP) * Possess a minimum of 3 years of ... This is a fully remote opportunity. #LI-JH #LI-Remote The role being advertised is an existing ...

Varsity Tutors

NCLEX-PN Tutor

Providence, RI · Remote

$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

See Providence, RI salary details

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$42

$69

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

As of Jun 13, 2026, the average hourly pay for remote utilization review rn in Providence, RI is $42.61, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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 popular job titles related to Remote Utilization Review Rn jobs in Providence, RI? For Remote Utilization Review Rn jobs in Providence, RI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Providence, RI look for? The top searched job categories for Remote Utilization Review Rn jobs in Providence, RI are:
What cities near Providence, RI are hiring for Remote Utilization Review Rn jobs? Cities near Providence, RI with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Case Management Pharmacist (Remote)

Pharmacy Careers

Providence, RI • On-site, Remote

Other

Posted 20 days ago

Job description

Case Management Pharmacist - Coordinate Care and Improve Patient Outcomes
A confidential managed care organization is hiring a detail-oriented Case Management Pharmacist to support patients with complex medication needs. This role focuses on coordinating care, preventing medication-related issues, and ensuring members receive the most appropriate therapy at the right time.
Key Responsibilities

  • Collaborate with physicians, nurses, and care coordinators to manage high-risk or complex patients.
  • Conduct medication reviews to identify gaps in therapy, adherence concerns, or potential drug interactions.
  • Support prior authorization and appeals processes when needed.
  • Educate patients and caregivers on medication regimens and disease state management.
  • Document case activities and outcomes in compliance with health plan and regulatory standards.
  • Participate in quality improvement initiatives to reduce hospitalizations and improve health outcomes.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Case management, MTM, or managed care experience preferred - retail and hospital pharmacists with strong patient counseling backgrounds are encouraged to apply.
  • Skills: Strong communication, problem-solving, and care coordination skills.


Why This Role?

  • Impact: Make a meaningful difference in patients' lives by ensuring safe and effective medication use.
  • Growth: Develop expertise in case management and managed care pharmacy.
  • Flexibility: Many organizations offer hybrid or fully remote work options.
  • Rewards: Competitive pay, benefits, and career advancement opportunities.

About Us
We are a confidential healthcare partner serving health plans and provider networks nationwide. Our case management pharmacists play a vital role in improving outcomes, reducing readmissions, and supporting patients across the continuum of care.
Apply Today
Apply now for our Case Management Pharmacist opportunity and join a team dedicated to patient-centered, coordinated care.

Apply