ZipRecruiter

Log In

2

Remote Utilization Review Manager Jobs in Nebraska

CHI Health

Utilization Review RN

Omaha, NE · On-site +1

$33.51 - $48.58/hr

Job Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in ... Your expertise in managed care environments and CMS standards will be essential in navigating payer ...

New

CSAA

$109K - $110K/yr

Optimize the allocation and utilization of resources across multiple programs, ensuring efficiency ... Regularly review and adjust critical metrics to align with evolving program goals. * Ensure ...

New

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 ...

Harris

$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

Cayenta

Work with colleagues and managers to implement and proactively manage superior utility CIS ... reviews and documentation, and requirements elicitation, allowing the project team to gain a ...

NextDeavor Inc.

Call Center Manager

Omaha, NE · Remote

$100K - $130K/yr

Manage, coach, and develop remote supervisors and agents through virtual leadership and performance reviews * Monitor and drive key KPIs including service levels, call volume, AHT, QA scores, and ...

next page

Showing results 1-20

All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Nebraska

Remote Utilization Review Manager information

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?

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 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 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:

What cities in Nebraska are hiring for Remote Utilization Review Manager jobs?

Cities in Nebraska with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you
Infographic showing various Remote Utilization Review Manager job openings in Nebraska as of August 2026, with employment types broken down into 82% Full Time, and 18% Part Time. Highlights an 100% Remote job distribution.

Utilization Review RN

CHI Health

Omaha, NE • On-site, Remote

$33.51 - $48.58/hr

Other

Posted 3 days ago

New

CHI Health rating

6.5

Company rating: 6.5 out of 10

Based on 130 frontline employees who took The Breakroom Quiz

609th of 895 rated healthcare providers

Job description

Where You'll Work
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.
Job Summary and Responsibilities
As our Utilization Review RN, you will play a pivotal role in optimizing healthcare delivery by ensuring medical necessity and appropriate patient status throughout the hospitalization journey. You will serve as a clinical expert, collaborating with attending physicians, consultants, and care coordination teams to apply evidence-based guidelines-such as MCG or InterQual-to facilitate seamless patient care transitions. Your expertise in managed care environments and CMS standards will be essential in navigating payer requirements, preventing claim denials, and upholding the high-quality standards of our health system.
Every day you will perform comprehensive admission and concurrent stay reviews to validate the clinical necessity of care, ensuring every patient interaction is documented with precision. You will engage in proactive denial prevention strategies, coordinate peer-to-peer reviews between providers and insurance payers, and communicate critical status updates to stakeholders. By balancing clinical data analysis with professional communication, you will ensure our facility remains compliant with regulatory agencies and Joint Commission standards while supporting the overall progression of care for our diverse patient population.
To be successful in this role, you will hold an active Registered Nurse (RN) license in NE or IA and possess at least two years of acute hospital clinical experience. We are seeking a detail-oriented professional with a strong grasp of utilization management programs, excellent time management skills, and the ability to thrive in a fast-paced, self-directed environment. Proficiency in clinical criteria application, a collaborative mindset, and a commitment to our organizational mission and core values are required to succeed as a key member of our utilization management team.
Job Requirements
Required
  • Graduate of an accredited school of nursing and 1-3 years Minimum two (2) years of acute hospital clinical experience , upon hire or
  • Masters Other In Case Management or Nursing field in lieu of 1 year experience., upon hire and
  • Registered Nurse: NE, upon hire or
  • Registered Nurse: IA, upon hire and

Preferred
  • Bachelors Of Science BSN in Nursing or related healthcare field and 4-6 years Five years of nursing experience, upon hire
  • Certified Case Manager, upon hire and
  • Accredited Case Manager, upon hire

What CHI Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply