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Remote Utilization Review Jobs in Pennsylvania (NOW HIRING)

Ourhrconnect

$309K - $413K/yr

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.

Ourhrconnect

$309K - $413K/yr

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.

Ourhrconnect

$309K - $413K/yr

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Pennsylvania

Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for remote utilization review in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 per hour, depending on experience, location, and employer.

What is a remote utilization review?

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.

What does a remote utilization review do?

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.

What are the key skills and qualifications needed to thrive in remote utilization review?

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.

What are the most commonly searched types of Utilization Review jobs in Pennsylvania?

The most popular types of Utilization Review jobs in Pennsylvania are:

What are popular job titles related to Remote Utilization Review jobs in Pennsylvania?

For Remote Utilization Review jobs in Pennsylvania, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Pennsylvania look for?

The top searched job categories for Remote Utilization Review jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Remote Utilization Review jobs?

Cities in Pennsylvania with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Pennsylvania as of August 2026, with employment types broken down into 91% Full Time, and 9% Part Time. Highlights an 100% Remote job distribution, with an average salary of $88,158 per year, or $42.4 per hour.

Clinical Pharmacy Specialist (Remote)- Care Management Team

UPMC Senior Communities

Pittsburgh, PA • On-site, Remote

$54.68 - $81.63/hr

Full-time

Posted 26 days ago

Job description

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Care Management team within the Pharmacy Services department. This is a work-from-home position, working Monday through Friday 8:30 a.m. to 5:00 p.m. EST. This is a remote position.
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required.
The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care. These services will be provided in compliance with state and federal regulations, NCQA, standards, the mission, policies and procedures of Health Plan and Pharmacy Department. Individual should demonstrate professionalism and commitment to meet UPMCHP goals and objectives.
Responsibilities:
The Care Management Pharmacist is primarily responsible for:
  • Managing and evaluating therapeutic drug interventions and other clinical pharmacy programs for the purpose of controlling pharmacy trend and improving pharmacy quality measures, including member and provider interventions, and evaluating outcomes for these programs, as well as considering comprehensive research projects.
  • Regularly interacting with interdisciplinary care teams to help best coordinate care for our members. Provide innovative and applicable ideas in clinical program development, utilization management, formulary management, provider education, therapeutic substitution, MTM/DUR, and/or improvements in programs and edits that already exist, including improving operational efficiencies, developing new clinical edits, and developing new quality improvement initiatives.Implement these new ideas or improvements as approved, while also considering outcomes of the programs.
  • Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other integrated programs with medical management. Create, develop, maintain, and enhance clinical reporting programs, including but not limited to physician specific reporting, alternative prescribing programs for utilization, assigned client plans, etc.

Additional responsibilities 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).
  • Special Skills/Ability to Interact: Have ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers, and clients. Honor client and patient confidentiality.
  • 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.
  • 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 in a timely manner 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 answering relevant questions.

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.
  • 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.

Preferred Experience:
  • Care Management - Managed care residency or 1-3 years managed care experience or at least 3 years of direct patient pharmacy practice experience, engaging in counseling and clinical services.cy practice experience, engaging in counseling and clinical services.
    Licensure, Certifications, and Clearances:
    Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.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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