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Remote Rn Utilization Review Nurse Jobs in Nebraska

Corvel

Telephonic Case Manager I

Omaha, NE · Remote

$63K - $95K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Corvel

Telephonic Case Manager I

Omaha, NE · Remote

$63K - $95K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Varsity Tutors

NCLEX-RN Tutor

Lincoln, NE · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Omaha, NE · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Humana

Reviews, assesses, and completes medical complexity attestations and clinical oversight activities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

Reviews, assesses, and completes medical complexity attestations and clinical oversight activities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

Humana

$71K - $87K/yr

Reviews, assesses, and completes medical complexity attestations and clinical oversight activities ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...

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Remote Rn Utilization Review Nurse information

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How much do remote rn utilization review nurse jobs pay per hour?

As of Jul 25, 2026, the average hourly pay for remote rn utilization review nurse in Nebraska is $40.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.88 and $46.30 per hour, depending on experience, location, and employer.

How to make an extra 2000 a month as a nurse?

A remote RN utilization review nurse can increase income by taking on additional shifts, working overtime, or pursuing specialized certifications such as CCM or CPHQ to qualify for higher-paying roles. Developing skills in case management, telehealth, or documentation can also open opportunities for freelance or consulting work to earn extra income.

What is the difference between Remote Rn Utilization Review Nurse vs Remote Rn Case Manager?

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

How to get into utilization review as a nurse?

To become a utilization review nurse, you typically need to be a registered nurse (RN) with clinical experience and obtain knowledge of insurance processes and healthcare regulations. Many employers prefer candidates with certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Gaining experience in case management, medical records review, or insurance settings can improve your chances of entering utilization review roles.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

What are the key skills and qualifications needed to thrive as a Remote RN Utilization Review Nurse, and why are they important?

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

What are some common challenges faced by Remote RN Utilization Review Nurses, and how can they be addressed?

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.

How can I make $2000 a week working from home?

A Remote Rn Utilization Review Nurse can potentially earn $2000 or more weekly by working full-time hours, often requiring specialized nursing experience, certification, and strong clinical assessment skills. Increasing income may involve taking on additional shifts, working for multiple employers, or gaining advanced certifications to qualify for higher-paying roles. Flexibility and efficiency with electronic health record tools can also enhance earning potential.

How to become a remote nurse reviewer?

To become a remote RN utilization review nurse, candidates typically need an active nursing license, experience in case management or utilization review, and familiarity with healthcare software and medical records. Certification in case management or utilization review, such as the Certified Case Manager (CCM), can enhance job prospects. Strong communication skills and the ability to work independently are also important for remote roles.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Nebraska? The most popular types of Rn Utilization Review Nurse jobs in Nebraska are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Nebraska? For Remote Rn Utilization Review Nurse jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Nebraska look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Nebraska are:
Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Nebraska as of July 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution, with an average salary of $83,852 per year, or $40.3 per hour.
Utilization Specialist

Utilization Specialist

Lutheran Family Services

Lincoln, NE • On-site, Remote

Full-time

Posted 24 days ago

Job description

Utilization Specialist
Job Type
Full-Time
Position Summary:
  • The Utilization Specialist uses strong independent judgment to ensure access to medically necessary, high-quality behavioral health and community-based services across the agency. The Utilization Specialist ensures services align with medical necessity, reimbursement requirements, and regulatory standards, while supporting continuity of care, reducing denials, and promoting operational sustainability while maintaining a client-centered focus.
Job Duties:
  • Serve as a liaison between managed care organizations (MCOs), payers, and internal clinical and operational teams to support authorization, utilization management, and reimbursement processes.
  • Conduct utilization reviews to ensure services meet medical necessity criteria, payer requirements, and continued stay expectations.
  • Monitor authorizations, service units, length of stay, and extensions; proactively communicate issues that may impact service delivery or reimbursement.
  • Coordinate pre-certifications and authorization requirements prior to service initiation in collaboration with admissions and intake staff.
  • Initiate and manage appeals for denied services or continued stay determinations, including facilitating peer-to-peer reviews as needed.
  • Review clinical documentation within the electronic health record to ensure accuracy, timeliness, and alignment with authorization and payer requirements.
  • Identify documentation gaps or compliance risks and provide guidance to staff on documentation standards and workflows.
  • Conduct quality and utilization reviews to assess appropriateness of services and compliance with payer and regulatory standards.
  • Monitor and report on non-certified days, denials, and utilization trends, including identifying root causes and opportunities for improvement.
  • Assist with internal, payer, and regulatory audits, including documentation review and response to data requests.
  • Develop and analyze utilization reports and metrics to support operational and clinical decision-making.
  • Provide training and ongoing education to staff on documentation standards, medical necessity, and utilization processes.
  • Serve as a resource for staff questions related to utilization management, documentation, and payer expectations.
  • Perform other duties as assigned to support program operations and organizational needs.
Required Skills/Abilities:
  • Expertise in utilization management, medical necessity, and managed care processes.
  • Strong written and verbal communication skills, with the ability to collaborate effectively across clinical, operational, and external stakeholders.
  • High attention to detail with strong organizational, analytical, and follow-through skills.
  • Proficiency in electronic health records and data tracking/reporting systems.
  • Able to analyze data, identify trends, and support process improvement efforts.
  • Commitment to confidentiality, ethical practice, and client-centered care.
  • Awareness and sensitivity of our constituents and the populations served by employees.
  • Regular and predictable attendance, and promptness for work.
  • Commitment to uphold the mission, vision, and values of Lutheran Family Services.
  • Support the organization’s objective to be an inclusive and accessible workplace.
Position Competencies:
  • Process Improvement
  • Relationship Building
  • Analytical Skills
  • Accountability
  • Communication Skills
Education and Experience:
  • High school diploma or equivalent required; bachelor’s degree in social work, behavioral health, nursing or related healthcare field preferred.
  • Two (2) years’ experience working with populations served by LFS or in a related clinical or behavioral health setting required.
  • Utilization Review experience highly preferred.
  • Experience in community mental health, CCBHC, or nonprofit human services preferred.
  • Active LPN, RN, MSW, CSW, LPC, or another clinical license in Nebraska preferred.
Physical Requirements:
  • Prolonged periods of sitting and working on a computer.
  • Hybrid or remote work may be available based on operational needs.
  • Flexible scheduling required during audits, appeal deadlines, or high-volume authorization periods.
  • Company-issued laptop and cell phone.
  • Valid driver’s license, liability auto insurance, and ability to drive a personal vehicle for travel between office locations and/or program sites, as needed.
Lutheran Family Services is an equal opportunity employer. We do not discriminate against any employee or applicant for employment on the basis of age, race, religion, color, ethnicity, disability, gender, sexual orientation, gender identity, or national origin.

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