... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
... join our remote MDS division as a Clinical Reimbursement Specialist . Clinical Reimbursement ... The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized ...
Remote Optum Utilization Review information
See Rochester, MN salary details
$21.75 - $26.15
2% of jobs
$26.15 - $30.54
9% of jobs
$33.55 is the 25th percentile. Wages below this are outliers.
$30.54 - $34.94
21% of jobs
The median wage is $38.50 / hr.
$34.94 - $39.34
23% of jobs
$39.34 - $43.74
13% of jobs
$47.16 is the 75th percentile. Wages above this are outliers.
$43.74 - $48.14
10% of jobs
$48.14 - $52.53
8% of jobs
$52.53 - $56.93
5% of jobs
$56.93 - $61.33
5% of jobs
$61.33 - $65.73
2% of jobs
$65.73 - $70.13
2% of jobs
$21
$42
$70
How much do remote optum utilization review jobs pay per hour?
As of Jul 22, 2026, the average hourly pay for remote optum utilization review in Rochester, MN is $42.98, according to ZipRecruiter salary data. Most workers in this role earn between $33.94 and $49.38 per hour, depending on experience, location, and employer.
What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?
| Aspect | Remote Optum Utilization Review | Remote UnitedHealthcare Utilization Review |
|---|---|---|
| Credentials | Licenses in relevant states, certifications like CCM or CRC often preferred | Licenses in relevant states, certifications like CCM or CRC often preferred |
| Work Environment | Remote, home-based with flexible hours | Remote, home-based with flexible hours |
| Employer & Industry | Optum, healthcare services and utilization management | UnitedHealthcare, health insurance and utilization review |
Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.
How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?
As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.
What is a Remote Optum Utilization Review position?
A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.
What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review Nurse, and why are they important?
To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What cities near Rochester, MN are hiring for Remote Optum Utilization Review jobs? Cities near Rochester, MN with the most Remote Optum Utilization Review job openings:
Other
Medical, Dental, Life, Retirement, PTO
Posted 13 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 division as a Clinical Reimbursement Specialist.
Clinical Reimbursement Specialist (CRS)
The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts
About Us:
At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
Responsibilities
Qualifications
Minimum Qualifications:
Key Rehab is an equal opportunity employer/service provider.
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist.
Clinical Reimbursement Specialist (CRS)
The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts
About Us:
At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
- Competitive salaries with bonus opportunities
- Ample opportunities for promotion, transfer, and advancement
- Work that is meaningful, fulfilling, and provides high job satisfaction
- Reasonable working hours promoting work-life balance
- Continuing education (CE) opportunities for ongoing professional development
- Generous paid time off
- Comprehensive health, dental, and life insurance packages
- 401K with discretionary matching
- Mileage and licensure reimbursements
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options
Responsibilities
- Serve as a trusted advisor to healthcare agencies and facilities, offering expert guidance and insights to optimize their operations.
- Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client.
- Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes.
- Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions.
- Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients.
- Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance.
- Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations.
- Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement.
Qualifications
Minimum Qualifications:
- Bachelor's degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process.
- Current and unrestricted RN ,along with active RAC-CT certification, ensuring adherence to industry standards and best practices.
- Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes.
- Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes.
Key Rehab is an equal opportunity employer/service provider.