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Remote Insurance Utilization Review Jobs in Kansas

Pharmacy Careers

Appeals Pharmacist (Remote)

Olathe, KS · On-site +1

$55.50 - $67.50/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Wichita, KS · On-site +1

$48.25 - $58.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Electric Power Research Institute, Inc.

$98K - $113K/yr

Charlotte, NC, Dallas, TX, EI - Canada Home Office, Knoxville, TN, Palo Alto, CA, Remote/Home Based ... accident insurance, paid time off (flexible vacation, sick leave, and holiday pay). EPRI ...

BetterHelp

Psychiatrist - Remote

Kansas City, KS · Remote

$119 - $242/hr

At the same time, only 30% of therapists accept insurance. UpLift acts as the bridge between ... utilization of add-on codes (such as 90833) when clinically appropriate and properly documented

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All JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Kansas

Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What are popular job titles related to Remote Insurance Utilization Review jobs in Kansas? For Remote Insurance Utilization Review jobs in Kansas, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Kansas look for? The top searched job categories for Remote Insurance Utilization Review jobs in Kansas are:
What cities in Kansas are hiring for Remote Insurance Utilization Review jobs? Cities in Kansas with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Kansas as of June 2026, with employment types broken down into 65% Full Time, 11% Part Time, 3% Temporary, 18% Contract, and 3% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution.
Utilization Review Clinician (RN, OT, or PT) - Remote

Utilization Review Clinician (RN, OT, or PT) - Remote

WellSky

Overland Park, KS • Remote

$2.5K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Key responsibilities

  • Conduct prior authorization reviews and continued stay reviews for post-acute care services by applying clinical guidelines and escalating cases to medical directors as needed.

  • Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions.

  • Approve services in compliance with health plan guidelines, contractual agreements, and medical necessity criteria.

WellSky rating

7.5

Company rating: 7.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

124th of 192 rated software companies

Job description

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This includes conducting patient evaluations, managing admissions and informational visits, and ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions.

In this role, you will also review requests for post-acute services promptly, using established clinical guidelines and coverage criteria to assess appropriateness. You'll collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes. By applying clinical expertise, you'll coordinate care with facilities and providers, follow standard operating procedures and organizational policies, and consult with peer reviewers, Medical Directors, or delegated clinical reviewers to ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process.

The ideal candidate will have working knowledge of Microsoft Office applications (e.g., Word, Excel) and be comfortable using clinical decision support tools and operational software.

Join us in shaping the future of healthcare - apply today!

Key Responsibilities:

  • Conduct prior authorization reviews and/or continued stay reviews for post-acute care services by applying clinical guidelines and escalating cases to medical directors as needed

  • Approve services in compliance with health plan guidelines, contractual agreements, and medical necessity criteria

  • Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions

  • Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth

  • Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes

  • Support all payer programs and initiatives related to the post-acute space

  • Make benefit determinations about appropriate levels of care using clinical guidelines

  • Coordinate benefits and transitions between various areas of care

  • Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively

  • Perform other job duties as assigned

Required Qualifications:

  • Bachelor's degree or equivalent work experience

  • 4-6 years of clinical nursing or therapy experience

  • Active RN, OT, or PT license

Preferred Qualifications:

  • 1-2 years' experience in utilization review, case management and/or managed care regulations

  • Experience with MCG Guidelines, InterQual or other clinical decision support tools, especially inutilization managementandprior authorizationprocesses

Job Expectations:

  • Willing to travel up to 30% based on business needs

  • Willing to work additional or irregular hours as needed

  • Must work in accordance with applicable security policies and procedures to safeguard company and client information

  • Must be able to sit and view a computer screen for extended periods of time

WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.

WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.

Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.

Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:

  • Excellent medical with Rx, dental, and vision benefits

  • Mental Health support through EAP

  • Generous paid time off, plus 13 paid holidays

  • 100% vested 401(K) retirement plans

  • Educational assistance up to $2500 per year

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