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Remote Utilization Review Jobs in Providence, RI

Bcbsri

Case Manager - Behavioral Health

Providence, RI · On-site +1

$73K - $110K/yr

Collaborate with the Utilization Review process including pre-authorization, concurrent review ... Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval ...

Bcbsri

Case Mgr - DSNP

Providence, RI · On-site +1

$73K - $110K/yr

Collaborate with the Utilization Review process including pre-authorization, concurrent review ... Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval ...

Cayenta

(Remote) Application Consultant

Carolina, RI · Remote

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

UNFI

Compensation Program Manager

Providence, RI · On-site +1

**Remote** Job Overview: The Compensation Program Manager partners with HR, Finance, and business ... utilization, pay-for-performance results, and compensation program effectiveness. * Manage ...

Citizens

Sr Benefits Specialist

Johnston, RI · On-site +1

$69K - $115K/yr

Analyze benefits utilization, financial performance, colleague feedback, and industry benchmarks to ... Develop and review educational materials, communications, and engagement strategies that improve ...

Citizens

Sr Benefits Specialist

Johnston, RI · On-site +1

$69K - $115K/yr

Analyze benefits utilization, financial performance, colleague feedback, and industry benchmarks to ... Develop and review educational materials, communications, and engagement strategies that improve ...

Citizens

Sr Benefits Specialist

Johnston, RI · On-site +1

$69K - $115K/yr

Analyze benefits utilization, financial performance, colleague feedback, and industry benchmarks to ... Develop and review educational materials, communications, and engagement strategies that improve ...

Johnson & Johnson

Senior Analyst Pricing

Raynham, MA · On-site +1

Raynham, Massachusetts, United States of America, Remote (US) About Orthopaedics Fueled by ... Support Market Access Readiness Review (MARR) process by developing new insights, connecting ...

Jj

Senior Analyst Pricing

Raynham, MA · On-site +1

Raynham, Massachusetts, United States of America, Remote (US) About Orthopaedics Fueled by ... Support Market Access Readiness Review (MARR) process by developing new insights, connecting ...

JLL

PDS Strategic Sourcing Specialist

Providence, RI · On-site +1

Participate and provide leadership to Preferred Supplier performance review meetings. * Support JLL ... Location: Remote -Boston, MA, Hartford, CT, New York, NY, Pittsburgh, PA, Providence, RI ...

VIVA USA INC

Nurse Case Manager

Woonsocket, RI · On-site +1

Fully remote (never coming onsite) Description: The Case Manager utilizes a collaborative process ... Through the use of clinical tools and information/data review, conducts comprehensive assessments ...

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Remote Utilization Review information

See Providence, RI salary details

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$42

$69

How much do remote utilization review jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for remote utilization review in Providence, RI is $42.71, according to ZipRecruiter salary data. Most workers in this role earn between $33.75 and $49.04 per hour, depending on experience, location, and employer.

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 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 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 are the most commonly searched types of Utilization Review jobs in Providence, RI?

The most popular types of Utilization Review jobs in Providence, RI are:

What are popular job titles related to Remote Utilization Review jobs in Providence, RI?

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

What job categories do people searching Remote Utilization Review jobs in Providence, RI look for?

The top searched job categories for Remote Utilization Review jobs in Providence, RI are:

What cities near Providence, RI are hiring for Remote Utilization Review jobs?

Cities near Providence, RI with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Providence, RI as of August 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,846 per year, or $42.7 per hour.

Remote Pharmacist - Prior Authorization / Coverage Determination

A-Line Staffing Solutions

Woonsocket, RI • Remote

$53/hr

Full-time

Medical, Dental, Vision

This job post has expired today. Applications are no longer accepted.

Job description

Remote Pharmacist – Prior Authorization / Coverage Determination

Pay Rate: $53.00/hr

Start Dates

  • September 7
  • September 28

Training Requirements

  • Mandatory paid training is held Monday – Friday, 9:00 AM – 5:30 PM EST for approximately 8–10 weeks.
  • Attendance is mandatory during training. No planned vacation or scheduling conflicts are permitted during this period.
  • Candidates must be available for the entire training schedule before accepting the assignment.
  • Camera must remain on during all virtual training sessions, supervisor meetings, and team meetings.

Schedule

Business Hours:

  • Monday – Friday: 7:00 AM – 8:00 PM EST
  • Saturday & Sunday: 7:00 AM – 4:30 PM EST

Schedule Type: Set Rotation

After training, candidates will be assigned an 8-hour shift based on business needs, which will include either:

  • One weekend day each week, or
  • A rotating weekend schedule.


Job Summary

We are seeking a licensed Registered Pharmacist to support a high-volume, remote Prior Authorization and Coverage Determination team. This role is responsible for reviewing pharmacy benefit requests, interpreting clinical criteria, evaluating Medicare Part D coverage determinations, and ensuring accurate, timely decisions while maintaining compliance with regulatory requirements.

The ideal candidate has experience in Pharmacy Benefit Management (PBM), prior authorizations, managed care, or clinical pharmacy operations and thrives in a productivity-driven remote environment with strict turnaround times.

This is a Safety Sensitive position.

Key Responsibilities

  • Review and evaluate prior authorization and coverage determination requests.
  • Interpret Medicare Part D guidelines, formulary requirements, and clinical criteria.
  • Apply evidence-based clinical judgment using drug information resources and clinical compendia.
  • Ensure compliance with CMS regulations, plan policies, and pharmacy benefit guidelines.
  • Document case reviews accurately and maintain audit-ready records.
  • Manage a high-volume case queue while meeting quality and productivity standards.
  • Perform provider outreach as needed to obtain clinical information or clarify requests.
  • Navigate multiple applications simultaneously while documenting case activity.
  • Work independently in a fast-paced remote environment with minimal supervision.
  • Participate in virtual meetings, coaching sessions, and required training.

Required Qualifications

  • Active Registered Pharmacist (RPh) license in good standing in the state of residence.
  • Experience with:
    • Pharmacy Benefit Management (PBM)
    • Prior Authorizations
    • Coverage Determinations
    • Medicare Part D
    • Formulary management
    • Drug Utilization Review (DUR)
  • Strong understanding of CMS regulations and managed care pharmacy.
  • Excellent documentation and data entry skills.
  • Experience working in high-volume, productivity-driven environments.
  • Strong computer skills, including Microsoft Excel and Word.
  • Ability to navigate multiple computer applications using dual monitors.

Preferred Qualifications

  • Experience with provider outreach and clinical case review.
  • Retail pharmacy combined with managed care or PBM experience.
  • Knowledge of Microsoft Access, PowerPoint, and Visio.
  • Previous remote clinical review experience.

Remote Work Requirements

Candidates must have:

  • A dedicated, quiet workspace free from interruptions.
  • Wired high-speed internet with a minimum of:
    • 25 Mbps download
    • 5 Mbps upload
  • Dual-monitor capability.
  • Ability to remain seated and focused throughout the workday.

Additional Requirements

  • Virtual interviews are conducted through Microsoft Teams.
  • Candidates must be comfortable with extensive data entry, multitasking, and working independently while maintaining productivity standards.
  • Opportunity for full-time employment based on performance.
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About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

Social media

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