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Remote Hca Utilization Review Jobs in Missouri (NOW HIRING)

Mosaic Life Care

Remote - Inpatient Coder II

Saint Joseph, MO · On-site +1

$21 - $25.25/hr

This assignment is based on evaluation of the documentation in the medical record and utilization ... Reviews and appeals coding denials. * Educates/Communicates with providers, querying providers to ...

ChenMed

$107K - $136K/yr

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

Mosaic Life Care

Remote - Inpatient Coder II

Saint Joseph, MO · On-site +1

$21 - $25.25/hr

... utilization of coding guidelines, Coding Clinic, knowledge of clinical disease processes and treatments. This position completes analysis and follow-up record reviews. Responsibilities * Codes ...

Unitedlex

Senior eDiscovery Project Manager

This is a remote position open to applicants throughout the United States. Overview of the Position ... Partners with the Document Review Manager to provide consolidated, consistent budgeting and ...

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Remote Hca Utilization Review information

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

AspectRemote Hca Utilization ReviewRemote Hca Case Manager
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalOften requires RN, social work, or case management certifications
Work EnvironmentPrimarily reviewing medical necessity and insurance coverage remotelyManaging patient cases, coordinating care, and discharge planning remotely
Employer & Industry UsageUsed by health insurance companies, healthcare providers, and utilization review organizationsEmployed by hospitals, insurance companies, and healthcare organizations

Remote Hca Utilization Review focuses on assessing medical necessity and insurance coverage, while Remote Hca Case Managers handle patient care coordination and discharge planning. Both roles require healthcare credentials and are integral to healthcare management, but they differ in daily responsibilities and focus areas.

What are popular job titles related to Remote Hca Utilization Review jobs in Missouri? For Remote Hca Utilization Review jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Remote Hca Utilization Review jobs in Missouri look for? The top searched job categories for Remote Hca Utilization Review jobs in Missouri are:
What cities in Missouri are hiring for Remote Hca Utilization Review jobs? Cities in Missouri with the most Remote Hca Utilization Review job openings:
Remote Hca Utilization Review jobs near you
Infographic showing various Remote Hca Utilization Review job openings in Missouri as of August 2026, with employment types broken down into 89% Full Time, and 11% Contract. Highlights an 100% Remote job distribution.

Supervisor, Utilization Management (RN)

Centene

Jefferson City, MO • On-site, Remote

$75K - $135K/yr

Full-time

Medical, Retirement, PTO

Posted 23 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 402 frontline employees who took The Breakroom Quiz

23rd of 887 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
  • Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
  • Collaborates with utilization management team to resolve complex care member issues
  • Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
  • Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
  • Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
  • Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
  • Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
  • Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
  • Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
  • Assists with onboarding, hiring, and training utilization management team members
  • Leads and champions change within scope of responsibility
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification:

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required
  • CA RN LICENSE REQUIRED
Pay Range: $75,300.00 - $135,400.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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