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Remote Utilization Review Jobs in Springfield, MA

Pharmacy Careers

Appeals Pharmacist (Remote)

Hartford, CT · On-site +1

$57.75 - $70.25/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

CVS Health

Case Manager, Registered Nurse

Hartford, CT · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · Remote

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · On-site +1

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Quest Global

Aftermarket Field Rep- Remote

Windsor, CT · Remote

$29 - $31/hr

Review data discrepancies and gaps across multiple systems. Escalate to appropriate channels. What ... History identifying and resolving part quality and delivery issues - including utilization of ...

Insurity

Manager, Professional Services

Hartford, CT · On-site +1

Drive utilization across team * Communicate financial and goal results, and KPIs to direct reports ... Demonstrated experience driving code quality through reviews, testing practices, and use of modern ...

Insurity

Manager, Professional Services

Hartford, CT · On-site +1

Drive utilization across team * Communicate financial and goal results, and KPIs to direct reports ... Demonstrated experience driving code quality through reviews, testing practices, and use of modern ...

ReSource Pro

Director Client Development

Hartford, CT · On-site +1

$120K - $205K/yr

All remote positions are based in the United States, and candidates must reside within the U.S. to ... Conduct quarterly and annual performance reviews tied to sales outcomes, including win rates, deal ...

All JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Springfield, MA

Remote Utilization Review information

See Springfield, MA salary details

$21

$42

$68

How much do remote utilization review jobs pay per hour?

As of Jun 19, 2026, the average hourly pay for remote utilization review in Springfield, MA is $42.13, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.37 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?

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 typical day look like for someone in a Remote Utilization Review role?

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 job?

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 popular job titles related to Remote Utilization Review jobs in Springfield, MA? For Remote Utilization Review jobs in Springfield, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Springfield, MA look for? The top searched job categories for Remote Utilization Review jobs in Springfield, MA are:
What cities near Springfield, MA are hiring for Remote Utilization Review jobs? Cities near Springfield, MA with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you

Remote Prior Authorization Pharmacist

Pharmacy Careers

Hartford, CT • Remote

$58.75 - $70.50/hr

Other

Posted 26 days ago

Job description

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

  • Review prior authorization requests for accuracy, appropriateness, and clinical necessity.
  • Apply plan criteria, evidence-based guidelines, and regulatory standards to determinations.
  • Communicate approval/denial decisions clearly to providers and patients.
  • Collaborate with physicians, nurses, and medical directors on complex cases.
  • Document outcomes in compliance with health plan policies and CMS/state regulations.
  • Support process improvements to streamline workflow and turnaround times.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply.
  • Skills: Excellent clinical review, documentation, and communication skills.

Why This Role?

  • Flexibility: 100% remote work from home with flexible scheduling options.
  • Impact: Directly influence patient access to safe and cost-effective medications.
  • Growth: Build specialized skills in utilization management and managed care.
  • Rewards: Competitive compensation, benefits, and career advancement opportunities.


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.

Apply