Lincoln, NE · Remote
$52.50 - $63.25/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Lincoln, NE · Remote
$52.50 - $63.25/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Omaha, NE · Remote
$55.75 - $67/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Omaha, NE · Remote
$55.75 - $67/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Omaha, NE · On-site +1
$201K - $320K/yr
Remote Categories: Underwriting, Leadership In this role, you'll shape medical policy, oversee ... Provide strategic direction for medical review activities, including utilization review, fraud ...
Omaha, NE · On-site +1
$201K - $320K/yr
Remote Categories: Underwriting, Leadership In this role, you'll shape medical policy, oversee ... Provide strategic direction for medical review activities, including utilization review, fraud ...
Lincoln, NE · On-site +1
$51.75 - $63/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Lincoln, NE · On-site +1
$51.75 - $63/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Omaha, NE · On-site +1
$54.75 - $66.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Omaha, NE · On-site +1
$54.75 - $66.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Lincoln, NE · Remote
$54K - $155K/yr
Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...
Lincoln, NE · Remote
$54K - $155K/yr
Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Quick apply
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Quick apply
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · Remote
$62K - $93K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Omaha, NE · On-site +1
$43K - $65K/yr
... remote/telecommuting opportunity Position Summary Assists in the study of the utilization of ... Initial application review will begin on the date provided in the field above. Applications ...
Omaha, NE · On-site +1
$43K - $65K/yr
... remote/telecommuting opportunity Position Summary Assists in the study of the utilization of ... Initial application review will begin on the date provided in the field above. Applications ...
Lincoln, NE · On-site +1
Conduct regular business reviews and use performance data, reporting, and insights to increase utilization, funded volume, and partner satisfaction * Consistently build and convert new national DSO ...
Lincoln, NE · On-site +1
Conduct regular business reviews and use performance data, reporting, and insights to increase utilization, funded volume, and partner satisfaction * Consistently build and convert new national DSO ...
Conduct regular business reviews and use performance data, reporting, and insights to increase utilization, funded volume, and partner satisfaction * Consistently build and convert new national DSO ...
Conduct regular business reviews and use performance data, reporting, and insights to increase utilization, funded volume, and partner satisfaction * Consistently build and convert new national DSO ...
Omaha, NE · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Omaha, NE · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Omaha, NE · On-site +1
This position allows remote flexibility but will have 2-3 days per week in the office. If living in ... Develop and maintain models for utilization trends * Partner with stakeholders to analyze trends in ...
Omaha, NE · On-site +1
This position allows remote flexibility but will have 2-3 days per week in the office. If living in ... Develop and maintain models for utilization trends * Partner with stakeholders to analyze trends in ...
Omaha, NE · Remote
$49K - $64K/yr
This role primarily operates in a remote work environment, with occasional travel required for ... Prepare and analyze reports related to benefits utilization and costs. * Review and approve monthly ...
Omaha, NE · Remote
$49K - $64K/yr
This role primarily operates in a remote work environment, with occasional travel required for ... Prepare and analyze reports related to benefits utilization and costs. * Review and approve monthly ...
Omaha, NE · Remote
$49K - $64K/yr
This role primarily operates in a remote work environment, with occasional travel required for ... Prepare and analyze reports related to benefits utilization and costs. * Review and approve monthly ...
Omaha, NE · Remote
$49K - $64K/yr
This role primarily operates in a remote work environment, with occasional travel required for ... Prepare and analyze reports related to benefits utilization and costs. * Review and approve monthly ...
Omaha, NE · On-site +1
$88K - $114K/yr
Provide leadership in utilization of Information Technology within Valmont as a trusted advisor to ... Review documentation and conduct training of end users/stakeholders. * Lead small to moderate ...
Omaha, NE · On-site +1
$88K - $114K/yr
Provide leadership in utilization of Information Technology within Valmont as a trusted advisor to ... Review documentation and conduct training of end users/stakeholders. * Lead small to moderate ...
Omaha, NE · On-site +1
$109K - $131K/yr
SQL, NoSQL, etc.), its configuration and utilization, and the optimization of the full data ... remote support.
Omaha, NE · On-site +1
$109K - $131K/yr
SQL, NoSQL, etc.), its configuration and utilization, and the optimization of the full data ... remote support.
Lead regular customer touchpoints (e.g., onboarding, QBRs/EBRs, health checks) to review usage ... Monitor account health via adoption, license activation, utilization, and customer feedback data.
Lead regular customer touchpoints (e.g., onboarding, QBRs/EBRs, health checks) to review usage ... Monitor account health via adoption, license activation, utilization, and customer feedback data.
$20.40 - $24.52
2% of jobs
$24.52 - $28.65
9% of jobs
$31.47 is the 25th percentile. Wages below this are outliers.
$28.65 - $32.77
21% of jobs
The median wage is $36.11 / hr.
$32.78 - $36.90
23% of jobs
$36.90 - $41.03
13% of jobs
$44.23 is the 75th percentile. Wages above this are outliers.
$41.03 - $45.15
10% of jobs
$45.15 - $49.28
8% of jobs
$49.28 - $53.40
5% of jobs
$53.40 - $57.53
5% of jobs
$57.53 - $61.65
2% of jobs
$61.65 - $65.78
2% of jobs
$20
$40
$65
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
$52.50 - $63.25/hr
Other
Posted 20 days ago
Remote Prior Authorization Pharmacist - Work From Home in Managed Care
A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe and effective therapies. This work-from-home position is ideal for pharmacists who want to transition out of retail or hospital settings while building expertise in managed care.
Key Responsibilities
What You'll Bring
Why This Role?
About Us
We are a confidential healthcare partner working with health plans and PBMs across the U.S.. Our pharmacists ensure patients receive the right therapy at the right time while maintaining compliance with all regulations.
Apply Today
Take the next step in your career with our Remote Prior Authorization Pharmacist opportunity - and enjoy the benefits of working from home while shaping the future of managed care.
