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Remote Behavioral Health Utilization Review Jobs in Nebraska

Aviary

$20 - $30/hr

Review patients progress, evaluating compliance and patient response to exercise * Lead group ... heart-healthy behaviors. * Promote the importance of regular attendance in the program * Sign ...

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Remote Behavioral Health Utilization Review information

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$20

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How much do remote behavioral health utilization review jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for remote behavioral health utilization review in Nebraska is $40.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.88 and $46.30 per hour, depending on experience, location, and employer.

What is a remote behavioral health utilization review?

A Remote Behavioral Health Utilization Review job involves evaluating behavioral health treatment plans and services to ensure they meet insurance guidelines, medical necessity, and regulatory requirements. Professionals in this role review clinical documentation, assess patient needs, and collaborate with healthcare providers to determine appropriate levels of care. They work remotely, often for insurance companies or healthcare organizations, to authorize or deny coverage based on established criteria. Strong clinical knowledge, attention to detail, and communication skills are essential for success in this role.

What are the typical daily responsibilities for someone working in remote behavioral health utilization review?

In a Remote Behavioral Health Utilization Review role, your daily tasks often include reviewing clinical documentation, assessing medical necessity for behavioral health services, and making authorization or denial recommendations according to established guidelines. You’ll frequently interact with providers, case managers, and insurance representatives to gather information and clarify care requests. Additionally, your day may involve documenting decisions, participating in case review meetings, and staying updated on evolving policies. Working remotely, you'll communicate primarily via secure electronic systems, phone, and video conferencing. This structure typically offers flexibility but also requires strong self-motivation and organization.

What are the key skills and qualifications needed to thrive in remote behavioral health utilization review, and why are they important?

To excel in Remote Behavioral Health Utilization Review, candidates generally need a clinical background such as a nursing or social work license, strong analytical skills, and experience with behavioral health diagnoses and treatment planning. Familiarity with utilization management software, electronic health records (EHRs), and insurance coding systems is often required, along with certifications like CCM (Certified Case Manager) or URAC accreditation being valued. Excellent communication, critical thinking, and organizational skills help professionals handle complex cases and collaborate effectively in a virtual team environment. These competencies ensure accurate review of mental health services, compliance with payer requirements, and optimal patient outcomes.

What are popular job titles related to Remote Behavioral Health Utilization Review jobs in Nebraska?

For Remote Behavioral Health Utilization Review jobs in Nebraska, the most frequently searched job titles are:

What job categories do people searching Remote Behavioral Health Utilization Review jobs in Nebraska look for?

The top searched job categories for Remote Behavioral Health Utilization Review jobs in Nebraska are:

Remote Behavioral Health Utilization Review jobs near you
Infographic showing various Remote Behavioral Health Utilization Review job openings in Nebraska as of August 2026, with employment types broken down into 82% Full Time, 14% Part Time, and 4% Contract. Highlights an 2% In-person, and 98% Remote job distribution, with an average salary of $83,852 per year, or $40.3 per hour.

Regional Reimbursement Nurse Consultant

Prestige Healthcare Management

Omaha, NE • Remote

$90K - $110K/yr

Full-time

Re-posted 9 days ago

Job description

Are you ready to make a change?

We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM, Case Mix Index, and RAI support to our long-term care and skilled nursing facilities.

This position will provide regional oversight to ensure accurate MDS completion, proper PDPM classification, optimized reimbursement, accurate case mix, regulatory compliance, and strong interdisciplinary team processes. Quarterly travel to assigned facilities will be required for on-site audits, training, clinical reimbursement review, and team support.

This role is ideal for a highly organized MDS professional with strong knowledge of PDPM, RAI guidelines, CMI, care planning, Medicare documentation, and long-term care reimbursement systems.

Key Responsibilities

  • Provide regional oversight for MDS, PDPM, CMI, and RAI processes

  • Monitor timely and accurate MDS completion across assigned facilities

  • Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy

  • Support Case Mix Index improvement through accurate assessment and documentation

  • Audit MDS assessments for accuracy, compliance, and missed reimbursement opportunities

  • Review Medicare Part A documentation and skilled coverage support

  • Assist with Triple Check and Medicare meetings

  • Support facility MDS Coordinators, DONs, Administrators, and interdisciplinary teams

  • Review care plans for accuracy and alignment with MDS assessments

  • Monitor ARD schedules, assessment calendars, significant change assessments, and discharge assessments

  • Provide education and coaching to facility MDS and clinical teams

  • Assist with RAI Manual interpretation and regulatory compliance

  • Identify trends, risks, late assessments, coding errors, and reimbursement concerns

  • Participate in monthly or quarterly reimbursement reviews with regional leadership

  • Travel quarterly to assigned facilities for audits, training, and operational support

Qualifications

  • Active RN license required

  • Long-term care/skilled nursing experience required

  • MDS experience required

  • Strong knowledge of PDPM, RAI, CMI, Medicare, and Medicaid case mix processes

  • Experience with multi-facility MDS oversight preferred

  • RAC-CT certification preferred

  • Experience with Triple Check, Medicare meetings, care planning, and reimbursement audits preferred

  • Strong understanding of RAI Manual requirements

  • Ability to work independently from home

  • Strong communication, organization, auditing, and follow-through skills

  • Ability to travel quarterly to assigned facilities

  • Experience with PCC or similar electronic health record system preferred

Compensation & Benefits

  • Competitive salary or hourly rate

  • Primarily remote/work-from-home position

  • Quarterly travel reimbursement

  • Mileage reimbursement

  • Lodging and meal reimbursement when overnight travel is required

  • Licensure or certification reimbursement as approved

  • Opportunity to support multiple facilities and directly impact reimbursement accuracy, compliance, and clinical outcomes