ZipRecruiter

Log In

2

Remote Utilization Review Manager Jobs in Chesterfield, MO

Workforce Connections

Denials Specialist

Saint Louis, MO · Remote

$23/hr

... reviews. This fully remote role supports utilization management by ensuring denial and approval letters are completed accurately, on time, and in compliance with regulatory requirements. The ideal ...

Workforce Connections

Denial Specialist

Saint Louis, MO · Remote

$22.47/hr

Denial Specialist (Remote) Pay Rate: $22.47 per hour Schedule: Multiple shifts available (details ... Previous experience in denials, appeals, or utilization management Disqualifiers * Candidates who ...

Solid Rock Recruiting LLC

Tax Manager

Saint Louis, MO · On-site +1

$125K - $200K/yr

Tax Manager - Public Accounting | Hybrid or Remote Overview: A top-tier public accounting firm is ... Lead client engagements, including planning, budgeting, and supervising tax preparation and review ...

next page

Showing results 1-20

All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Chesterfield, MO

Remote Utilization Review Manager information

See Chesterfield, MO salary details

$38.6K

$90.1K

$165.8K

How much do remote utilization review manager jobs pay per year?

As of Aug 25, 2026, the average yearly pay for remote utilization review manager in Chesterfield, MO is $90,078.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,900.00 and $108,400.00 per year, depending on experience, location, and employer.

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 Chesterfield, MO?

For Remote Utilization Review Manager jobs in Chesterfield, MO, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Chesterfield, MO look for?

The top searched job categories for Remote Utilization Review Manager jobs in Chesterfield, MO are:

What cities near Chesterfield, MO are hiring for Remote Utilization Review Manager jobs?

Cities near Chesterfield, MO with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Supervisor, Utilization Management (RN)

Saint Louis, MO • On-site, Remote

Centene
Health Care and Social Assistance • 10K+ employees

8.4

Company rating: 8.4 out of 10

Based on 405 frontline employees who took The Breakroom Quiz

14th of 893 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Centeneexternal

$75K - $135K/yr

Full-time

Medical, Retirement, PTO

Re-posted 6 days ago

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
  • Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
  • Collaborates with utilization management team to resolve complex care member issues
  • Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
  • Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
  • Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
  • Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
  • Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
  • Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
  • Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
  • Assists with onboarding, hiring, and training utilization management team members
  • Leads and champions change within scope of responsibility
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification:

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required
  • CA RN LICENSE REQUIRED
Pay Range: $75,300.00 - $135,400.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

What Centene employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply