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Remote Insurance Utilization Review Jobs in Nebraska

Mutual of Omaha

VP & Medical Director

Omaha, NE · On-site +1

$201K - $320K/yr

Remote Categories: Underwriting, Leadership In this role, you'll shape medical policy, oversee ... Provide strategic direction for medical review activities, including utilization review, fraud ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Lincoln, NE · On-site +1

$51.75 - $63/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)

Omaha, NE · On-site +1

$54.75 - $66.75/hr

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

CVS Health

Case Manager, Registered Nurse

Lincoln, NE · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CSAA

Job Title Commercial Insurance Analytics Consultant - Remote Requisition Number R7735 Commercial ... Reviews and guides work performed by less senior analysts , delegating components of analysis ...

BetterHelp

Psychiatrist - Remote

Lincoln, NE · 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

CSAA Insurance Group, a AAA Insurer

... Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and ... Review and process purchase requisitions and change orders * Execute sourcing activities, primarily ...

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All JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Nebraska

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
VP & Medical Director

VP & Medical Director

Mutual of Omaha

Omaha, NE • On-site, Remote

$201K - $320K/yr

Other

Retirement, PTO

Posted 6 days ago

Mutual Of Omaha rating

8.6

Company rating: 8.6 out of 10

Based on 58 frontline employees who took The Breakroom Quiz

74th of 261 rated insurance

Job description

VP & Medical Director

Apply now Job no: 504719
Work type: Full Time Regular
Location: Remote
Categories: Underwriting, Leadership

In this role, you'll shape medical policy, oversee complex case reviews, and guide strategic decisions that support sound risk management and high-quality claim and underwriting outcomes. This position blends hands-on clinical expertise with executive leadership and cross-functional collaboration.

WHAT WE CAN OFFER YOU:

  • Estimated Salary: $201,000 - $320,000, plus annual bonus opportunity.
  • 401(k) plan with a 2% company contribution and 6% company match.
  • Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
  • Applicants for this position must not now, nor at any point in the future, require sponsorship for employment. 

WHAT YOU'LL DO:

  • Lead and oversee medical review operations supporting underwriting and claims, ensuring efficient workflows and high-quality outcomes.
  • Develop and maintain medical policies, protocols, and guidelines to support accurate and defensible decision-making.
  • Review complex medical cases, including high-risk, denied, and appealed claims, and provide final-level medical consultation when needed.
  • Provide strategic direction for medical review activities, including utilization review, fraud detection, and risk management initiatives.
  • Partner with business leaders to support new product development, underwriting philosophy, and claims strategies.
  • Manage departmental operations, including budgeting, staffing, training, and short- and long-term planning.
  • Represent the organization in internal leadership forums and external medical director meetings, collaborating with peers and industry experts.

WHAT YOU'LL BRING:

  • Medical degree (MD or DO) with an unrestricted license to practice medicine.
  • Clinical background in internal medicine, family medicine, or primary care.
  • Experience reviewing medical cases within insurance underwriting and/or claims environments.
  • Demonstrated leadership experience managing medical teams or programs.
  • Strong analytical and decision-making skills with the ability to interpret complex medical information.
  • Excellent communication and relationship-building skills with both clinical and business stakeholders.
  • Strong organizational and planning skills with the ability to manage multiple priorities.
  • You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
  • Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

PREFERRED:

  • Prior experience supporting underwriting functions within insurance operations.
  • Experience developing medical policy or contributing to product development initiatives.

We value diverse experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply! 

If you have questions about your application or the hiring process, email our Talent Acquisition area at careers@mutualofomaha.com. Please allow at least one week from time of applying if you are checking on the status.

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Mutual of Omaha only accepts applications from mutualofomaha.com/careers. Legitimate communications will come from '@mutualofomaha.com.' We never request sensitive information or extend job offers without conducting interviews. For more details, check our Hiring FAQs. Stay alert for scams and apply securely!

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Advertised: Apr 10, 2026 09:00 AM Central Daylight Time
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