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Remote Utilization Review Jobs in Springfield, MA

DataAnnotation

RN

Hartford, CT · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

RN

Springfield, MA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

Registered Nurse

Hartford, CT · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

Registered Nurse

Springfield, MA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

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How much do remote utilization review jobs pay per hour?

As of May 30, 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 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 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.
More about Remote Utilization Review jobs
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:
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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 Registered Nurse (RN) Case Manager

Valeris

Hartford, CT • Remote

$50K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.
As a Nurse Advocate you are responsible for contact with program patients and assessing any barriers that may be present for successful initiation and completion of therapy. The Nurse Advocate will play an active role with each patient from the first point of patient program enrollment and throughout treatment to facilitate a timely and successful patient experience.
Key Responsibilities:
  • Serve as a consistent resource throughout the continuum of program services, which includes identifying barriers to therapy and helping the patient understand and navigate such barriers.
  • Serve as an educator who possesses knowledge and practical experience about clinical treatments and the strong emotions and financial implications associated with a new diagnosis, living with a chronic medical condition or life-threatening condition.
  • Enable patients by providing them with information and education about:
    • their prescribed therapy and course of treatment, fairly balanced with benefits and known side effects per manufacturer product information
    • proper administration and dosing of prescribed therapy
    • calling and working with the patient’s insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient
    • support to help better manage the stress involved in their diagnosis.
    • Empower the patient to participate in their personal care process by triaging the patient to support for other non-program needs such as social or other intervention programs.
  • Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices
  • Utilize Valeris’ values as the driving force behind the team’s success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned
Qualifications:
  • Must have active RN licensure in current state of practice.
  • 2-3 years of nursing experience with relevant disease state experience preferred.
  • Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus.
  • Case management or Clinical Trial Nurse experience, a plus.
  • Bachelor's degree preferred.
  • Remote work eligibility is subject to all work from home criteria met and based on business need.
Physical Demands amp; Work Environment
  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
  • Although very minimal, flexibility to travel as needed is preferred.
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
Why Work for Valeris?
We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:
  • Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
  • Additional health support, including telehealth and Employee Assistance Program (EAP) services
  • Company match on Health Savings Account contributions
  • Free Basic Life and AD amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
  • Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
  • 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
  • Paid Time Off (PTO) and Sick Leave to support work-life balance
  • Team members receive nine paid holidays plus two floating holidays
  • Opportunities for advancement in a company that supports personal and professional growth
  • A challenging, stimulating work environment that encourages new ideas
  • Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
  • A mission-driven, inclusive culture where your work makes a meaningful impact
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
Our Commitment to Equal Opportunity
At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.
Important Notice

Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.

Please Note:
  • PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
  • We will never request your bank account information at any stage of the hiring process.
  • We will never send a check (electronic or physical) to purchase home office equipment.

If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com

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