South Jordan, UT · Remote
$55.25 - $66.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
South Jordan, UT · Remote
$55.25 - $66.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Lehi, UT · Remote
$54.75 - $65.75/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Lehi, UT · Remote
$54.75 - $65.75/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Lehi, UT · On-site +1
$53.75 - $65.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Lehi, UT · On-site +1
$53.75 - $65.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
South Jordan, UT · On-site +1
$54.25 - $66.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
South Jordan, UT · On-site +1
$54.25 - $66.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
$52K - $68K/yr
May provide utilization management review and authorization of behavioral health (BH) and substance ... Remote
$52K - $68K/yr
May provide utilization management review and authorization of behavioral health (BH) and substance ... Remote
$52K - $68K/yr
May provide utilization management review and authorization of behavioral health (BH) and substance ... Remote
$52K - $68K/yr
May provide utilization management review and authorization of behavioral health (BH) and substance ... Remote
Salt Lake City, UT · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... utilization management, disease management, auditing, or retrospective review * Active ...
Salt Lake City, UT · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... utilization management, disease management, auditing, or retrospective review * Active ...
Provo, UT · On-site +1
$80K/yr
... are utilization. Together with our health plan partners, we are changing the way our society ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...
Provo, UT · On-site +1
$80K/yr
... are utilization. Together with our health plan partners, we are changing the way our society ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...
It will also help pioneer the build-out and utilization of a proprietary battery storage / energy ... reviewing and making recommendations on commercial agreements (PPA, O&M, Transmission ...
It will also help pioneer the build-out and utilization of a proprietary battery storage / energy ... reviewing and making recommendations on commercial agreements (PPA, O&M, Transmission ...
It will also help pioneer the build\-out and utilization of a proprietary battery storage \/ energy ... reviewing and making recommendations on commercial agreements (PPA, O&M, Transmission ...
It will also help pioneer the build\-out and utilization of a proprietary battery storage \/ energy ... reviewing and making recommendations on commercial agreements (PPA, O&M, Transmission ...
Remote Business Unit Description: Foot and Ankle The Regional Sales Manager (RM) is responsible for ... Conduct regular ride-alongs, field visits, and business reviews with reps and DPs to ensure ...
Remote Business Unit Description: Foot and Ankle The Regional Sales Manager (RM) is responsible for ... Conduct regular ride-alongs, field visits, and business reviews with reps and DPs to ensure ...
Midvale, UT · On-site +1
Set clear performance expectations, provide regular coaching, and conduct performance reviews for ... Optimize the sales process, pipeline management, and CRM utilization to improve efficiency and ...
New
Midvale, UT · On-site +1
Set clear performance expectations, provide regular coaching, and conduct performance reviews for ... Optimize the sales process, pipeline management, and CRM utilization to improve efficiency and ...
New
Blanding, UT · On-site +1
$57K - $97K/yr
Uses remote management software tools to maintain and update configuration, protocol and user ... Reviews and evaluates proposed software. Provides input to briefings and presentations on the ...
Blanding, UT · On-site +1
$57K - $97K/yr
Uses remote management software tools to maintain and update configuration, protocol and user ... Reviews and evaluates proposed software. Provides input to briefings and presentations on the ...
Lehi, UT · On-site +1
... review. NetDocuments is the world's #1 trusted cloud-based content management and productivity ... Two-time winner (2024, 2023) Top Workplace Innovation * 2025 Remote Work * 2024 Technology Industry ...
Lehi, UT · On-site +1
... review. NetDocuments is the world's #1 trusted cloud-based content management and productivity ... Two-time winner (2024, 2023) Top Workplace Innovation * 2025 Remote Work * 2024 Technology Industry ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Fully remote role. Candidates must reside within the assigned territory (TX, NM, AZ, UT, CO, KS, MO ... Review and analyze regional reports to prioritize existing and new prospects. Partner with internal ...
Fully remote role. Candidates must reside within the assigned territory (TX, NM, AZ, UT, CO, KS, MO ... Review and analyze regional reports to prioritize existing and new prospects. Partner with internal ...
Salt Lake City, UT · On-site +1
$14/hr
This is a remote position for those that reside in = AL, GA, ID, IA, IN, KS, LA, MI, MS, NV, NC, ND ... Resource & System Utilization * Utilize Privia-approved billing systems, EMR platforms, tools, and ...
Salt Lake City, UT · On-site +1
$14/hr
This is a remote position for those that reside in = AL, GA, ID, IA, IN, KS, LA, MI, MS, NV, NC, ND ... Resource & System Utilization * Utilize Privia-approved billing systems, EMR platforms, tools, and ...
Salt Lake City, UT · Remote
$14/hr
This is a remote position for those that reside in = AL, GA, ID, IA, IN, KS, LA, MI, MS, NV, NC, ND ... Resource & System Utilization * Utilize Privia-approved billing systems, EMR platforms, tools, and ...
Salt Lake City, UT · Remote
$14/hr
This is a remote position for those that reside in = AL, GA, ID, IA, IN, KS, LA, MI, MS, NV, NC, ND ... Resource & System Utilization * Utilize Privia-approved billing systems, EMR platforms, tools, and ...
Eden, UT · Remote
Lead recurring performance calls (bi-monthly or monthly) to review campaign results, align on ... Own client-facing budget pacing conversations and ensure alignment on utilization, flighting, and ...
Eden, UT · Remote
Lead recurring performance calls (bi-monthly or monthly) to review campaign results, align on ... Own client-facing budget pacing conversations and ensure alignment on utilization, flighting, and ...
Salt Lake City, UT · Remote
$19.20 - $34.90/hr
Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and ... Obtain and organize drug utilization data including patient-specific and population-based data in a ...
Salt Lake City, UT · Remote
$19.20 - $34.90/hr
Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and ... Obtain and organize drug utilization data including patient-specific and population-based data in a ...
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.
$55.25 - $66.50/hr
Other
Posted 19 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.
