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Remote Insurance Utilization Review Jobs in Missouri

MDS Solutions

REMOTE MDS Coordinator

Kansas City, MO · On-site +1

$33.50 - $42.75/hr

  • Medical

  • Life

  • Retirement

  • PTO

Comprehensive health and life insurance. * 401K with discretionary match * Mileage and licensure ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Kansas City, MO · Remote

$33.50 - $42.75/hr

  • Medical

  • Life

  • Retirement

  • PTO

Comprehensive health and life insurance. * 401K with discretionary match * Mileage and licensure ... Review and verify MDS documentation and charting requirements to support the clinical services ...

Centene

DRG Reviewer

Florissant, MO · On-site +1

$70K - $126K/yr

  • Medical

  • Retirement

  • PTO

Remote Role: 4+ years experience of performing MS-DRG and APR-DRG coding required. In-patient and ... Applies advanced knowledge of coding guidelines and clinical policies throughout the review process ...

Centene

DRG Reviewer

Jefferson City, MO · On-site +1

$70K - $126K/yr

  • Medical

  • Retirement

  • PTO

Remote Role: 4+ years experience of performing MS-DRG and APR-DRG coding required. In-patient and ... Applies advanced knowledge of coding guidelines and clinical policies throughout the review process ...

Centene

DRG Reviewer

Kansas City, MO · On-site +1

$70K - $126K/yr

  • Medical

  • Retirement

  • PTO

Remote Role: 4+ years experience of performing MS-DRG and APR-DRG coding required. In-patient and ... Applies advanced knowledge of coding guidelines and clinical policies throughout the review process ...

Centene

DRG Reviewer

Columbia, MO · On-site +1

$70K - $126K/yr

  • Medical

  • Retirement

  • PTO

Remote Role: 4+ years experience of performing MS-DRG and APR-DRG coding required. In-patient and ... Applies advanced knowledge of coding guidelines and clinical policies throughout the review process ...

Centene

DRG Reviewer

Kansas City, MO · On-site +1

$70K - $126K/yr

  • Medical

  • Retirement

  • PTO

Remote Role: 4+ years experience of performing MS-DRG and APR-DRG coding required. In-patient and ... Applies advanced knowledge of coding guidelines and clinical policies throughout the review process ...

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 ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Missouri

Remote Insurance Utilization Review information

What is a remote insurance utilization review?

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 skills and qualifications are needed for a remote insurance utilization review specialist?

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.

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 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.

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 August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 100% Remote job distribution.

REMOTE MDS Coordinator

MDS Solutions

Kansas City, MO • On-site, Remote

$33.50 - $42.75/hr

Other

Medical, Life, Retirement, PTO

Re-posted 20 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

Apply