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Remote Utilization Review Manager 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 ... utilization review, fraud detection, and risk management initiatives. * Partner with business ...

Mutual of Omaha

VP & Medical Director

Omaha, NE · On-site +1

$201K - $320K/yr

Remote Categories: Underwriting, Leadership As our VP & Medical Director, you'll shape medical ... utilization review, fraud detection, and risk management initiatives. * Partner with business ...

Harris

Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Our program offers a customized model of remote care services that blends Chronic Care Management ...

Pacificlife

Cyber Security Review Program Lead

Omaha, NE · On-site +1

$106K - $143K/yr

... day remote. How you'll help move us forward: * Own the end-to-end design, governance, and ... Manage the relationship, execution, and oversight of our external managed service provider ...

Imedica

Supervisor, Clinical Quality Review

Omaha, NE · Remote

Key Accountabilities * Assist Manager with supporting an efficient department operation and ... Oversee & assist with medical record retrieval work including remote electronic health record (EHR ...

Harris

Facilitate bid/no-bid reviews with Sales and leadership, applying clear criteria to protect team ... Manage the human review workflow: route AI-generated drafts to the right reviewers, track feedback ...

Harris

Facilitate bid/no-bid reviews with Sales and leadership, applying clear criteria to protect team ... Manage the human review workflow: route AI-generated drafts to the right reviewers, track feedback ...

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Remote Utilization Review Manager information

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

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

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

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

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

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are popular job titles related to Remote Utilization Review Manager jobs in Nebraska? For Remote Utilization Review Manager jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Nebraska look for? The top searched job categories for Remote Utilization Review Manager jobs in Nebraska are:
Remote Utilization Review Manager jobs near you
Infographic showing various Remote Utilization Review Manager job openings in Nebraska as of July 2026, with employment types broken down into 82% Full Time, and 18% Part Time. Highlights an 100% Remote job distribution.
Utilization Specialist

Utilization Specialist

Lutheran Family Services

Lincoln, NE • On-site, Remote

Full-time

Posted 14 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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