(REMOTE) Registered Nurse (RN) - Prior Authorization | Job ID: 242999

Medix™; Town of Texas (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health care provider is seeking a remote Utilization Review Registered Nurse (RN) to manage medication safety and efficiency for patients with chronic conditions. The role demands a Texas RN license, a minimum of 2 years in utilization management, and expertise in PBM processes. You will educate patients about medication usage and ensure seamless communication between all parties involved in patient care.

Benefits

Medical insurance

Vision insurance

Disability insurance

Paid paternity leave

Paid maternity leave

401(k)

Qualifications

• Minimum 2 years of experience in prior authorization or utilization management.
• Strong understanding of PBM processes and medication coverage criteria.
• Clinical knowledge in chronic disease management.

Responsibilities

• Oversee patients’ medication needs from initial review through follow-up.
• Conduct medication reconciliations and escalate safety concerns.
• Coordinate with pharmacy teams for reports and follow-through.

Skills

Critical Thinking

Time Management

Communication

Education

Active Texas Registered Nurse License

Tools

EMR systems

Prior Authorization Tools

Microsoft Office Suite

Job description

(REMOTE) Utilization Review, Registered Nurse (RN) | Job ID: 242999

(REMOTE) Utilization Review, Registered Nurse (RN) | Job ID: 242999

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This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$45.00/hr - $50.00/hr

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Schedule: Monday–Friday, 8:00 AM – 5:00 PM

Pay Rate: $45–$50/hour (based on experience)

Overview:

We are seeking an experienced and detail-oriented Registered Nurse (RN) to support prior authorization requests and medication management education in a remote capacity. This role focuses on optimizing medication safety, streamlining access to care, and supporting positive health outcomes—especially for patients managing chronic conditions such as diabetes.

Key Responsibilities:

• Oversee patients’ medication needs from initial review through post-treatment follow-up.
• Conduct thorough medication reconciliations, identify drug-related issues, and escalate safety concerns when necessary.
• Coordinate with pharmacy teams and Pharmacy Benefit Managers (PBMs) to track adverse drug events and ensure proper reporting and follow-through.
• Support the prior authorization process for medications requiring pre-approval by collaborating with prescribers and payers.
• Assist in preparing and submitting appeals for denied medications, providing necessary clinical documentation and supporting the patient’s case.
• Educate patients on medication usage, potential side effects, administration, and recovery timelines.
• Serve as a liaison among patients, providers, pharmacists, and internal teams to ensure clear, timely communication and care coordination.
• Collaborate with utilization management and clinical operations teams to inform workflows, technology use, and policy development.
• Accurately document all assessments, interventions, and communications in accordance with regulatory and payer standards.
• Track medication utilization and adherence metrics; analyze trends to identify areas for process improvement.
• Partner with analytics teams to develop medication-related reports and dashboards.

Requirements:

• Active, unrestricted Texas Registered Nurse (RN) license.
• **Current residence within the state of Texas even though this is remote, current Texas Residence is required due to restrictions).**
• Minimum 2 years of experience in prior authorization or utilization management at a health plan or PBM.
• Strong understanding of PBM processes, medication coverage criteria, and appeals workflows.
• Clinical knowledge in chronic disease management and pharmacotherapy.
• Excellent time management, critical thinking, and communication skills.
• Proficiency with EMR systems, prior authorization tools, and Microsoft Office Suite.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

Disability insurance

Paid paternity leave

Paid maternity leave

401(k)

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