Annandale, VA · On-site +1
$57 - $69.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Annandale, VA · On-site +1
$57 - $69.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Pasadena, MD · On-site +1
$58.25 - $70.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Pasadena, MD · On-site +1
$58.25 - $70.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Experience: 5 years' clinically related experience working in Discharge Coordination and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG; previous post-acute ...
Experience: 5 years' clinically related experience working in Discharge Coordination and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG; previous post-acute ...
... and utilization review. • Secure contracts and agreements, where necessary or optimal, to ... remote and in-person, and manage follow-up. • Collaborate with Customer Success to onboard new ...
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... and utilization review. • Secure contracts and agreements, where necessary or optimal, to ... remote and in-person, and manage follow-up. • Collaborate with Customer Success to onboard new ...
Baltimore, MD · Remote
Experience: 5 years' clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Baltimore, MD · Remote
Experience: 5 years' clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Baltimore, MD · Remote
Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Baltimore, MD · Remote
Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
We go beyond merely providing a remote work option; we support and embrace it. We offer ... Prior utilization management, peer review, or appeals experience (helpful but not required). Equal ...
We go beyond merely providing a remote work option; we support and embrace it. We offer ... Prior utilization management, peer review, or appeals experience (helpful but not required). Equal ...
Reston, VA · On-site +1
$71.75 - $92.50/hr
Advisory & Governance Reviews * Provide strategic technical advisory services to programs and ... utilization. Business Product Management * Ensure customer and program needs are met through ...
Reston, VA · On-site +1
$71.75 - $92.50/hr
Advisory & Governance Reviews * Provide strategic technical advisory services to programs and ... utilization. Business Product Management * Ensure customer and program needs are met through ...
Suitland, MD · Remote
$60 - $78.25/hr
NAT; segmentation; remote access and site-to-site VPN; RSA SecurID or equivalent MFA/two-factor ... Perform recurring firewall rule base reviews, rule recertification, policy cleanup, decommissioning ...
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Suitland, MD · Remote
$60 - $78.25/hr
NAT; segmentation; remote access and site-to-site VPN; RSA SecurID or equivalent MFA/two-factor ... Perform recurring firewall rule base reviews, rule recertification, policy cleanup, decommissioning ...
Suitland, MD · On-site +1
$63 - $82.50/hr
NAT; segmentation; remote access and site-to-site VPN; RSA SecurID or equivalent MFA/two-factor ... Perform recurring firewall rule base reviews, rule recertification, policy cleanup, decommissioning ...
Suitland, MD · On-site +1
$63 - $82.50/hr
NAT; segmentation; remote access and site-to-site VPN; RSA SecurID or equivalent MFA/two-factor ... Perform recurring firewall rule base reviews, rule recertification, policy cleanup, decommissioning ...
Clinton, MD · Remote
$2K - $2K/mo
Train, mentor, and evaluate team performance of 3 remote bookkeepers 2. Bookkeeping Operations ... Review: * Profit & Loss statements * Balance sheets * General ledger activity * Ensure timely ...
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Clinton, MD · Remote
$2K - $2K/mo
Train, mentor, and evaluate team performance of 3 remote bookkeepers 2. Bookkeeping Operations ... Review: * Profit & Loss statements * Balance sheets * General ledger activity * Ensure timely ...
Clinton, MD · Remote
$2K - $2K/mo
Train, mentor, and evaluate team performance of 3 remote bookkeepers 2. Bookkeeping Operations ... Review: * Profit & Loss statements * Balance sheets * General ledger activity * Ensure timely ...
Quick apply
Clinton, MD · Remote
$2K - $2K/mo
Train, mentor, and evaluate team performance of 3 remote bookkeepers 2. Bookkeeping Operations ... Review: * Profit & Loss statements * Balance sheets * General ledger activity * Ensure timely ...
Vienna, VA · Remote
$86K - $138K/yr
Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ... Participates in onsite meetings and business reviews to support relationship development · Other ...
Vienna, VA · Remote
$86K - $138K/yr
Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ... Participates in onsite meetings and business reviews to support relationship development · Other ...
Vienna, VA · On-site +1
$86K - $138K/yr
Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ... Participates in onsite meetings and business reviews to support relationship development • Other ...
Vienna, VA · On-site +1
$86K - $138K/yr
Tracks utilization, service adoption, and client feedback; flags issues early and addresses routine ... Participates in onsite meetings and business reviews to support relationship development • Other ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Drive accountability through routine performance scorecards, operational reviews, and metric-based ... utilization, revenue cycle performance, and cost structures. * Mentor and support operational ...
Bethesda, MD · On-site +1
$84K - $99K/yr
... utilization management initiatives ... Develop routine and ad hoc reports, dashboards, and summaries to support client reviews and ...
Bethesda, MD · On-site +1
$84K - $99K/yr
... utilization management initiatives ... Develop routine and ad hoc reports, dashboards, and summaries to support client reviews and ...
Washington, DC · 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 ...
Washington, DC · 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 ...
Washington, DC · Remote
$115K - $145K/yr
Primarily desk-side / remote from the Contractor's office or home office (CONUS including Alaska ... Standardize requirements analysis methodology and review products for completeness. Minimum ...
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Washington, DC · Remote
$115K - $145K/yr
Primarily desk-side / remote from the Contractor's office or home office (CONUS including Alaska ... Standardize requirements analysis methodology and review products for completeness. Minimum ...
$22.12 - $26.59
2% of jobs
$26.59 - $31.06
9% of jobs
$34.12 is the 25th percentile. Wages below this are outliers.
$31.06 - $35.54
21% of jobs
The median wage is $39.16 / hr.
$35.54 - $40.01
23% of jobs
$40.01 - $44.48
13% of jobs
$47.96 is the 75th percentile. Wages above this are outliers.
$44.48 - $48.96
10% of jobs
$48.96 - $53.43
8% of jobs
$53.43 - $57.90
5% of jobs
$57.90 - $62.37
5% of jobs
$62.37 - $66.85
2% of jobs
$66.85 - $71.32
2% of jobs
$22
$43
$71
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.
$57 - $69.50/hr
Other
Posted 17 days ago
Appeals Pharmacist - Ensure Fair Medication Access for Patients
A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.
Key Responsibilities
What You'll Bring
Why This Role?
About Us
We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.
Apply Today
Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.
