Nashville, TN · Remote
$56.25 - $67.50/hr
We are seeking a Multi-State Licensed Pharmacist for a remote Medication Therapy Management (MTM ... Chronic disease state management Drug utilization review (DUR) Formulary management and navigation ...
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Nashville, TN · Remote
$56.25 - $67.50/hr
We are seeking a Multi-State Licensed Pharmacist for a remote Medication Therapy Management (MTM ... Chronic disease state management Drug utilization review (DUR) Formulary management and navigation ...
Nashville, TN · Remote
$60K - $107K/yr
Retirement
Compact RN license * 2 years of acute inpatient case management experience/utilization review * 1 years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or ...
Nashville, TN · Remote
$60K - $107K/yr
Retirement
Compact RN license * 2 years of acute inpatient case management experience/utilization review * 1 years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or ...
Nashville, TN · Remote
$60K - $107K/yr
Retirement
Compact RN license * 2 years of acute inpatient case management experience/utilization review * 1 years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or ...
Nashville, TN · Remote
$60K - $107K/yr
Retirement
Compact RN license * 2 years of acute inpatient case management experience/utilization review * 1 years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or ...
Nashville, TN · On-site +1
Medical
Dental
Vision
Retirement
PTO
Organization: Utilization Management Job Summary: Manager within the Utilization Management ... Annually review current policies. Create, update and/or maintain section, department and applicable ...
Nashville, TN · On-site +1
Medical
Dental
Vision
Retirement
PTO
Organization: Utilization Management Job Summary: Manager within the Utilization Management ... Annually review current policies. Create, update and/or maintain section, department and applicable ...
Brentwood, TN · Remote
$18.25 - $24.50/hr
Medical
Retirement
Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members. If you are located in or within commutable driving ...
Brentwood, TN · Remote
$18.25 - $24.50/hr
Medical
Retirement
Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members. If you are located in or within commutable driving ...
Brentwood, TN · On-site +1
$18.25 - $24.50/hr
Medical
Retirement
Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members. If you are located in or within commutable driving ...
Brentwood, TN · On-site +1
$18.25 - $24.50/hr
Medical
Retirement
Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members. If you are located in or within commutable driving ...
Nashville, TN · Remote
$43 - $56/hr
Participate in utilization review and authorization processes in coordination with ACT's billing and operations teams. Family & Caregiver Collaboration * Provide caregiver training and coaching to ...
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Nashville, TN · Remote
$43 - $56/hr
Participate in utilization review and authorization processes in coordination with ACT's billing and operations teams. Family & Caregiver Collaboration * Provide caregiver training and coaching to ...
Nashville, TN · Remote
$17.50 - $23.25/hr
... Billing, Utilization Review, Outreach and Clinical * Support client-related requests from the ... LI-Remote Based on the nature of this role, you will need to complete several state background ...
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Nashville, TN · Remote
$17.50 - $23.25/hr
... Billing, Utilization Review, Outreach and Clinical * Support client-related requests from the ... LI-Remote Based on the nature of this role, you will need to complete several state background ...
Nashville, TN · On-site +1
... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ... Remote in any state except, NY, CA, HI and AK VIVA is an equal opportunity employer. All qualified ...
Nashville, TN · On-site +1
... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ... Remote in any state except, NY, CA, HI and AK VIVA is an equal opportunity employer. All qualified ...
Nashville, TN · On-site +1
remote in any state except, NY, CA, HI and AK Description: Nurse Case Management Senior Analyst ... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ...
Nashville, TN · On-site +1
remote in any state except, NY, CA, HI and AK Description: Nurse Case Management Senior Analyst ... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ...
Nashville, TN · Remote
$180 - $200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
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Nashville, TN · Remote
$180 - $200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
Nashville, TN · Remote
$200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
Nashville, TN · Remote
$200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
Nashville, TN · On-site +1
$200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
Nashville, TN · On-site +1
$200/hr
... reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced remote ...
Brentwood, TN · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
... capital utilization. * Support the consolidation and analysis of annual budgets and forecasts ... For further information, please review the Know Your Rights notice from the Department of Labor.
Brentwood, TN · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
... capital utilization. * Support the consolidation and analysis of annual budgets and forecasts ... For further information, please review the Know Your Rights notice from the Department of Labor.
Nashville, TN · Remote
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
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Nashville, TN · Remote
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Quick apply
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Manager, Supply Chain Remote Company Overview: AMSURG is an independent leader in ambulatory ... Produce monthly vendor utilization reports for each corporate contract by center * Perform various ...
Brentwood, TN · Remote
$75K - $85K/yr
Medical
Dental
Vision
Retirement
PTO
Conduct regular business reviews and field visits. * Identify barriers to growth and create action ... This is a remote position.
Quick apply
Brentwood, TN · Remote
$75K - $85K/yr
Medical
Dental
Vision
Retirement
PTO
Conduct regular business reviews and field visits. * Identify barriers to growth and create action ... This is a remote position.
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Work Schedule: Remote ESSENTIAL RESPONSIBILITIES: * Maintain comprehensive awareness of the ... Track and manage project timelines, deliverables, and resource utilization to ensure projects are ...
Nashville, TN · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Work Schedule: Remote ESSENTIAL RESPONSIBILITIES: * Maintain comprehensive awareness of the ... Track and manage project timelines, deliverables, and resource utilization to ensure projects are ...
$20.66 - $24.83
2% of jobs
$24.83 - $29.01
9% of jobs
$31.87 is the 25th percentile. Wages below this are outliers.
$29.01 - $33.19
21% of jobs
The median wage is $36.57 / hr.
$33.19 - $37.37
23% of jobs
$37.37 - $41.55
13% of jobs
$44.79 is the 75th percentile. Wages above this are outliers.
$41.55 - $45.72
10% of jobs
$45.72 - $49.90
8% of jobs
$49.90 - $54.08
5% of jobs
$54.08 - $58.26
5% of jobs
$58.26 - $62.43
2% of jobs
$62.43 - $66.61
2% of jobs
$20
$40
$66
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.
The most popular types of Utilization Review jobs in Lebanon, TN are:
For Remote Utilization Review jobs in Lebanon, TN, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in Lebanon, TN are:
Cities near Lebanon, TN with the most Remote Utilization Review job openings:
$56.25 - $67.50/hr
Full-time
Posted 5 days ago
We are seeking a Multi-State Licensed Pharmacist for a remote Medication Therapy Management (MTM) Consulting opportunity. This 13-week assignment is ideal for pharmacists with clinical experience who enjoy patient engagement, medication optimization, and collaboration with healthcare providers.
Candidates licensed in one or more of the following states are encouraged to apply:
California*
Indiana
South Carolina
Illinois
Missouri
New Jersey
Iowa
New Hampshire
North Dakota
South Dakota
Utah
Washington
West Virginia
Arkansas
Kansas
Maine
Montana
Oklahoma
Virginia
Wyoming
Louisiana (strongly preferred)
Key Responsibilities
Conduct virtual patient consultations through phone or video, including Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs).
Address medication-related questions, side effects, and adherence barriers.
Provide medication therapy recommendations to improve patient outcomes.
Review prior authorization requests, formulary exceptions, and step-therapy requirements according to clinical guidelines.
Collaborate with prescribers and healthcare teams through secure messaging and phone consultations.
Recommend cost-effective, formulary-aligned medication alternatives when appropriate.
Perform proactive clinical outreach for gaps in care, including chronic disease management opportunities.
Support formulary initiatives and assist with clinical rules and medication utilization processes.
Review complex claims data and support PBM-related clinical activities.
Maintain accurate documentation while ensuring compliance with HIPAA, state telepharmacy regulations, and client requirements.
Required Qualifications
Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
Active, unrestricted pharmacist license in the state of operation.
Multi-state licensure strongly preferred.
Minimum of 2 years of clinical pharmacy experience.
Experience in PBM, managed care, MTM, or telehealth pharmacy strongly preferred.
Strong knowledge of:
Chronic disease state management
Drug utilization review (DUR)
Formulary management and navigation
Proficiency with telehealth platforms, electronic health records (EHR), and PBM claims systems.
Excellent verbal and written communication skills with the ability to interact professionally with patients, providers, and healthcare teams.
Apply Today
For more information or to apply, please contact:
Yvette Sonera
224-208-1138 or email yvette.sonera@rphonthego.com
#p34
Sourced by ZipRecruiter
At RPh on the Go, we’re all about pharmacists. As a company started by pharmacists for pharmacists, we understand the extraordinary responsibilities you take on every day, the tremendous demands placed on you and your colleagues, and the rewards that come with working in one of the country’s most highly respected professions.
Recruiting and staffing services
201 - 500 Employees
Chicago, IL, US
1980
