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Remote Rn Utilization Review Nurse Jobs in Des Moines, IA

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

Remote. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our ... Provide telephonic case management and utilization review for assigned consumers. * Develop ...

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

Remote. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our ... Provide telephonic case management and utilization review for assigned consumers. * Develop ...

Varsity Tutors

NCLEX-RN Tutor

Ames, IA · 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 ...

MDS Solutions

REMOTE MDS Coordinator

Carlisle, IA · Remote

$33.25 - $42.50/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Carlisle, IA · On-site +1

$33.25 - $42.50/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Carlisle, IA · On-site +1

$33.25 - $42.50/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

Corvel

Care Advocate Nurse

West Des Moines, IA · Remote

$61K - $98K/yr

... ies), reviews medical data in CareMC, validates and secures medical information, assesses and ... This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Initiates and receives telephonic ...

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Remote Rn Utilization Review Nurse information

See Des Moines, IA salary details

$20

$41

$67

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

As of Aug 25, 2026, the average hourly pay for remote rn utilization review nurse in Des Moines, IA is $41.26, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.40 per hour, depending on experience, location, and employer.

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?

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.

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.

What are the most commonly searched types of Rn Utilization Review Nurse jobs in Des Moines, IA?

The most popular types of Rn Utilization Review Nurse jobs in Des Moines, IA are:

What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Des Moines, IA?

For Remote Rn Utilization Review Nurse jobs in Des Moines, IA, the most frequently searched job titles are:

What job categories do people searching Remote Rn Utilization Review Nurse jobs in Des Moines, IA look for?

The top searched job categories for Remote Rn Utilization Review Nurse jobs in Des Moines, IA are:

Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Des Moines, IA as of August 2026, with employment types broken down into 84% Full Time, 5% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,829 per year, or $41.3 per hour.

Regional Reimbursement Nurse Consultant

West Des Moines, IA • Remote

Prestige Healthcare Management
See more jobs at Prestige Healthcare Managementexternal

$90K - $110K/yr

Full-time

Re-posted 24 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