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Remote Insurance Utilization Review Jobs in Ohio

CSAA

Marketing Engagement Partner - Remote

Delaware, OH · Remote

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 ...

Imh

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

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

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

REMOTE MDS NURSE (RN) - WISCONSIN

Concept Rehab & Engage Consulting

Toledo, OH • Remote

Other

Posted 7 days ago

Job description

Description

 REMOTE MDS NURSE (RN) - WISCONSIN
Full-Time | Work From Home

Engage Consulting is seeking an experienced Registered Nurse (RN) with strong MDS, Case Mix, PDPM, Medicare, Medicaid, and Quality Measure experience to join our growing team.

This is a full-time remote opportunity for an RN who enjoys working independently while partnering with skilled nursing facilities to improve reimbursement, maintain regulatory compliance, and support quality resident care.


WHAT YOU'LL DO

Complete, review, and audit MDS assessments for accuracy and compliance with CMS and state regulations

Ensure timely completion of MDS assessments and supporting documentation

Analyze Case Mix and PDPM opportunities to maximize reimbursement

Review and improve Quality Measures through accurate assessments and clinical documentation

Partner with interdisciplinary teams to strengthen documentation and reimbursement outcomes

Provide education and support related to MDS processes, reimbursement, and regulatory requirements

Maintain accurate records while meeting deadlines in a remote work environment

Assist with compliance initiatives and reimbursement optimization


WHAT WE'RE LOOKING FOR

Active Wisconsin Registered Nurse (RN) license or active Nurse Licensure Compact (NLC) license

Recent MDS experience in a Skilled Nursing Facility (SNF)

Strong knowledge of PDPM, Medicare, Medicaid, and Case Mix reimbursement

Experience managing Quality Measures

Excellent communication, organization, and critical thinking skills

Ability to work independently in a remote setting

Experience with electronic medical records and MDS software


PREFERRED

RAC-CT Certification

Multi-facility MDS experience


WHY JOIN ENGAGE CONSULTING?

100% Remote Position

Full-Time Opportunity

Competitive Compensation

Flexible Work Environment

Supportive and Collaborative Team

Opportunity to work with skilled nursing facilities throughout Wisconsin

Make a meaningful impact on reimbursement, compliance, and resident outcomes

If you're an experienced MDS RN looking for a rewarding remote opportunity where your expertise makes a difference every day, we'd love to hear from you.


Apply today and join the Engage Consulting team!

Apply