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Remote Insurance Utilization Review Jobs in Nebraska

AIL

Mobile Insurance Office Manager

Omaha, NE · Remote

Fully Remote Position - Enjoy the freedom to work from anywhere. * Six-Figure Earning Potential ... Provide ongoing policy support, including policy reviews, beneficiary updates, and claims ...

Mutual of Omaha

VP & Medical Director

Omaha, NE · On-site +1

$201K - $320K/yr

Remote Categories: Underwriting, Leadership As our VP & Medical Director, you'll shape medical ... Provide strategic direction for medical review activities, including utilization review, fraud ...

CSAA

Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements ... CSAA Insurance Group is an equal opportunity employer. #li-ml1 . The national average salary range ...

CSAA

Job Title Senior Data Science Consultant, Insurance - Remote Requisition Number R7828 Senior Data ... Coach and mentor junior consultants and review modeling work for quality and rigor. * Support ...

Mutual of Omaha

VP & Medical Director

Omaha, NE · Remote

$201K - $320K/yr

Remote Categories: Claims/Claims Processing We're seeking a talented professional to partner with ... Provide professional oversight for medical review, utilization analysis, and claim review. Conduct ...

Harris

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

CSAA

Our mission is to reinvent commercial insurance in the mobility space to offer our partners ... Reviews existing work processes to prioritize and execute internal department improvements. * Makes ...

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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 popular job titles related to Remote Insurance Utilization Review jobs in Nebraska? For Remote Insurance Utilization Review jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Nebraska look for? The top searched job categories for Remote Insurance Utilization Review jobs in Nebraska are:
What cities in Nebraska are hiring for Remote Insurance Utilization Review jobs? Cities in Nebraska with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you

Regional Reimbursement Nurse Consultant

Prestige Healthcare Management

Omaha, NE • Remote

$90K - $110K/yr

Full-time

Re-posted 19 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