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Remote Anthem Utilization Review Nurse Jobs in Rochester, MN

MDS Solutions

REMOTE MDS Coordinator

Rochester, MN · On-site +1

$33.50 - $42.75/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Rochester, MN · On-site +1

$33.50 - $42.75/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Rochester, MN · Remote

$33.50 - $42.75/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

Scribe-X

Remote Medical Scribe

Rochester, MN · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a ... Review completed charts with the provider between patients or at the completion of shift * Update ...

All JobsAnthem Utilization Review Nurse JobsRemote Anthem Utilization Review Nurse JobsRemote Anthem Utilization Review Nurse Jobs in Rochester, MN

Remote Anthem Utilization Review Nurse information

See Rochester, MN salary details

$21

$42

$70

How much do remote anthem utilization review nurse jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for remote anthem utilization review nurse in Rochester, MN is $42.98, according to ZipRecruiter salary data. Most workers in this role earn between $33.94 and $49.38 per hour, depending on experience, location, and employer.

What is a Remote Anthem Utilization Review Nurse?

A Remote Anthem Utilization Review Nurse is a registered nurse who works from home to review medical cases and claims for Anthem, a major health insurance company. Their primary role is to assess whether the healthcare services provided to members are medically necessary and align with Anthem’s policies and guidelines. They analyze patient records, collaborate with healthcare providers, and ensure that the care given is appropriate and cost-effective. By working remotely, these nurses use secure digital platforms to perform their duties, offering flexibility while maintaining high standards of care review.

What are the key skills and qualifications needed to thrive as a Remote Anthem Utilization Review Nurse?

To thrive as a Remote Anthem Utilization Review Nurse, you need a valid RN license, strong clinical judgment, and experience in utilization management or case review. Familiarity with medical management software, electronic health records, and accreditation standards such as NCQA or URAC is typically required. Excellent communication, critical thinking, and time management skills are essential for effective collaboration and decision-making in a virtual environment. These competencies ensure accurate reviews, regulatory compliance, and efficient care coordination for Anthem members.

What are some common challenges faced by Remote Anthem Utilization Review Nurses, and how can they be managed?

Remote Anthem Utilization Review Nurses often encounter challenges such as balancing high caseloads, navigating complex insurance guidelines, and maintaining effective communication with healthcare providers and patients from a distance. Staying organized and up-to-date with payer policies can help manage workload efficiently. Using secure communication platforms and participating in regular virtual team meetings also aids in building collaboration and ensuring accurate, timely reviews. Proactively seeking clarification on ambiguous cases and utilizing available support resources can further help overcome day-to-day obstacles in this remote role.

What is the difference between Remote Anthem Utilization Review Nurse vs Remote Case Manager?

AspectRemote Anthem Utilization Review NurseRemote Case Manager
CredentialsRN license, certifications in utilization reviewRN or social work license, case management certification
Work EnvironmentHealthcare insurance, utilization review teamsHealthcare providers, insurance companies, patient advocacy
Employer & IndustryHealth insurance companies like Anthem, healthcare industry

Remote Anthem Utilization Review Nurses focus on reviewing medical necessity and appropriateness of care for insurance claims, primarily within insurance companies. Remote Case Managers coordinate patient care, discharge planning, and resource management across healthcare settings. While both roles require healthcare knowledge and RN credentials, utilization review nurses specialize in insurance review processes, whereas case managers focus on patient care coordination.

What are popular job titles related to Remote Anthem Utilization Review Nurse jobs in Rochester, MN?

For Remote Anthem Utilization Review Nurse jobs in Rochester, MN, the most frequently searched job titles are:

What job categories do people searching Remote Anthem Utilization Review Nurse jobs in Rochester, MN look for?

The top searched job categories for Remote Anthem Utilization Review Nurse jobs in Rochester, MN are:

What cities near Rochester, MN are hiring for Remote Anthem Utilization Review Nurse jobs?

Cities near Rochester, MN with the most Remote Anthem Utilization Review Nurse job openings:

Remote Anthem Utilization Review Nurse jobs near you
Infographic showing various Remote Anthem Utilization Review Nurse job openings in Rochester, MN as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $89,397 per year, or $43 per hour.

REMOTE MDS Coordinator

MDS Solutions

Rochester, MN • On-site, Remote

$33.50 - $42.75/hr

Other

Medical, Life, Retirement, PTO

Re-posted 2 days ago

Job description

Overview
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group. The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us! We thrive on Quality Resident Care.
This role requires a RN license, LPN will not meet the minimum qualifications.
What do we offer you?
  • Creative, fun, and flexible working environment
  • The following benefits:
  • Competitive salaries and bonuses.
  • Comprehensive health and life insurance.
  • 401K with discretionary match
  • Mileage and licensure reimbursements.
  • Flexible Spending Account and HSA
  • Reasonable working hours.
  • CE opportunities.
  • Paid sick, holiday, and vacation leave.
  • Promotion/Transfer/Advancement opportunities.
  • Meaningful work and job satisfaction.

Responsibilities
  • MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team.
  • Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident.
  • Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed.
  • Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions.
  • Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident.
  • Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken.
  • Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement.

Qualifications
  • Nursing Experience in MDS Assessment: 3+ year
  • RAC-CT preferred
  • RN Required
  • Thorough understanding of PDPM requirements
  • Able to negotiate through EMR and possess strong computer skills
  • Promotes and demonstrates excellence in customer service

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