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Remote Insurance Utilization Review Jobs in Missouri

Unitedlex

Consultant - Document Review - Virtual

$70K - $90K/yr

This is a remote position, and we welcome applicants from throughout the country. See "About Us ... insurance, as well as an EAP plan that covers employees and household members. Our suite of ...

Unitedlex

Sr Consultant - Document Review - Virtual

$100K - $115K/yr

... remote position, and we welcome applicants from throughout the country. See "About Us" for more ... insurance, as well as an EAP plan that covers employees and household members. Our suite of ...

Unitedlex

Director of Document Review

This is a remote position, and we welcome applicants from throughout the country. See "About Us ... insurance, as well as an EAP plan that covers employees and household members. Our suite of ...

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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 the most commonly searched types of Insurance Utilization Review jobs in Missouri? The most popular types of Insurance Utilization Review jobs in Missouri are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Missouri? For Remote Insurance Utilization Review jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Missouri look for? The top searched job categories for Remote Insurance Utilization Review jobs in Missouri are:
What cities in Missouri are hiring for Remote Insurance Utilization Review jobs? Cities in Missouri 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 Missouri as of July 2026, with employment types broken down into 84% Full Time, and 16% Temporary. Highlights an 100% Remote job distribution.

RN, Utilization Review - PRN

Saint Luke's Hospital System

Kansas City, MO • Remote

Part-time

This job post has expired today. Applications are no longer accepted.

Job description

Job DescriptionSaint Luke's is looking to add to the UR team!

Schedule: Day Shift

Status: PRN - 1 shift required every 2 weeks

  • MO/KS RN license required

  • Case Management experience preferred

  • Min of 2 years bedside experience preferred

  • Remote position; will cover all campuses

The Opportunity:

The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.

  • Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual).

  • Complies with CMS regulation regarding utilization review/management.

  • Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact.

  • Submits referrals for secondary level review as appropriate and follows through on process.

  • Documents communication and work in electronic medical record.

  • Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing.

Why Saint Luke's?

  • We believe in work/life balance.

  • We are dedicated to innovation and always looking for ways to improve.

  • We believe in creating a collaborative environment where all voices are heard.

  • We are here for you and will support you in achieving your goals.

Job Requirements

Applicable Experience:

Less than 1 yearRegistered Nurse - VariousAssociate DegreeJob DetailsPRNDay (United States of America)

The best place to get care. The best place to give care. Saint Luke's 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.

Apply