Omaha, NE · Remote
$90K - $110K/yr
We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote ... Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy
Quick apply
Omaha, NE · Remote
$90K - $110K/yr
We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote ... Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy
Kearney, NE · Remote
$69.41 - $103.25/hr
Job Summary and Responsibilities This is a remote position suporting the Central Area Region ... care management and utilization review; Applies strategies within daily operations to identify ...
Kearney, NE · Remote
$69.41 - $103.25/hr
Job Summary and Responsibilities This is a remote position suporting the Central Area Region ... care management and utilization review; Applies strategies within daily operations to identify ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Management will be conducting interviews with those candidates who are the most qualified, with ...
New
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Management will be conducting interviews with those candidates who are the most qualified, with ...
New
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Management will be conducting interviews with those candidates who are the most qualified, with ...
New
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Management will be conducting interviews with those candidates who are the most qualified, with ...
New
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 ...
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 ...
Omaha, NE · Remote
Review and sign off on complex tax returns (1120, 1120S, 1065, 1040 HNW) * Manage client ... Experience with remote team leadership and workflow management tools (e.g., CCH, ProSystem ...
Quick apply
Omaha, NE · Remote
Review and sign off on complex tax returns (1120, 1120S, 1065, 1040 HNW) * Manage client ... Experience with remote team leadership and workflow management tools (e.g., CCH, ProSystem ...
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 ...
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 ...
Omaha, NE · Remote
$65K - $80K/yr
Manages mid-level general liability & product liability claims by gathering information to ... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ...
Omaha, NE · Remote
$65K - $80K/yr
Manages mid-level general liability & product liability claims by gathering information to ... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ...
Omaha, NE · Remote
$65K - $80K/yr
Manages mid-level general liability & product liability claims by gathering information to ... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ...
Omaha, NE · Remote
$65K - $80K/yr
Manages mid-level general liability & product liability claims by gathering information to ... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ...
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 ...
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 ...
... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
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 ...
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 ...
Job Title Process Manager, Commercial Casualty Claims - Remote Requisition Number R7810 Process ... Reviews existing work processes to prioritize and execute internal department improvements. * Makes ...
Job Title Process Manager, Commercial Casualty Claims - Remote Requisition Number R7810 Process ... Reviews existing work processes to prioritize and execute internal department improvements. * Makes ...
Omaha, NE · Remote
$80K - $98K/yr
... utilization of counsel is appropriate, proper negotiation strategy is employed. * Provides ... and manages litigation process. * Attend settlement conferences on serious injury claims.
Quick apply
Omaha, NE · Remote
$80K - $98K/yr
... utilization of counsel is appropriate, proper negotiation strategy is employed. * Provides ... and manages litigation process. * Attend settlement conferences on serious injury claims.
WSP is currently initiating a search for a Transmission Line Project Manager- Remote in our Power ... Establish the level of technical review required for the project, selecting appropriately qualified ...
WSP is currently initiating a search for a Transmission Line Project Manager- Remote in our Power ... Establish the level of technical review required for the project, selecting appropriately qualified ...
WSP is currently initiating a search for a Transmission Line Project Manager- Remote in our Power ... Establish the level of technical review required for the project, selecting appropriately qualified ...
WSP is currently initiating a search for a Transmission Line Project Manager- Remote in our Power ... Establish the level of technical review required for the project, selecting appropriately qualified ...
$10/hr
Remote Care Manager Location: Remote The Care Manager will be assigned a patient panel based on ... EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min
$10/hr
Remote Care Manager Location: Remote The Care Manager will be assigned a patient panel based on ... EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min
Omaha, NE · On-site +1
$57K - $85K/yr
... Remote/Telecommuting No remote/telecommuting opportunity Position Summary Responsible for ... Provide data management support and works to ensure trials move forward toward enrollment goals.
Omaha, NE · On-site +1
$57K - $85K/yr
... Remote/Telecommuting No remote/telecommuting opportunity Position Summary Responsible for ... Provide data management support and works to ensure trials move forward toward enrollment goals.
Omaha, NE · On-site +1
$57K - $85K/yr
... Remote/Telecommuting No remote/telecommuting opportunity Position Summary Responsible for ... Provide data management support and works to ensure trials move forward toward enrollment goals.
Omaha, NE · On-site +1
$57K - $85K/yr
... Remote/Telecommuting No remote/telecommuting opportunity Position Summary Responsible for ... Provide data management support and works to ensure trials move forward toward enrollment goals.
Omaha, NE · On-site +1
$73K - $110K/yr
Initial application review will begin on the date provided in the field above. Applications ... 6. Utilization of knowledge and skills related to meeting age-specific needs of the patient ...
Omaha, NE · On-site +1
$73K - $110K/yr
Initial application review will begin on the date provided in the field above. Applications ... 6. Utilization of knowledge and skills related to meeting age-specific needs of the patient ...
| Aspect | Remote Utilization Review Manager | Remote Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like URAC or AAPC, and management experience | Licensed Registered Nurse (RN) with utilization review certification often preferred |
| Work Environment | Oversees review teams, manages processes, and ensures compliance remotely | Performs case reviews, assesses medical necessity, and documents findings remotely |
| Employer & Industry Usage | Health 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.
$90K - $110K/yr
Full-time
Re-posted 24 days ago
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
