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Remote Utilization Review Nurse Jobs in Iowa (NOW HIRING)

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

MDS Solutions

REMOTE MDS Coordinator

Cedar Rapids, IA · On-site +1

$33.75 - $43/hr

  • Medical

  • Life

  • Retirement

  • PTO

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

Cedar Rapids, IA · Remote

$33.75 - $43/hr

  • Medical

  • Life

  • Retirement

  • PTO

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 · Remote

$33.25 - $42.50/hr

  • Medical

  • Life

  • Retirement

  • PTO

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

  • Medical

  • Life

  • Retirement

  • PTO

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

  • Medical

  • Life

  • Retirement

  • PTO

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

Cedar Rapids, IA · On-site +1

$33.75 - $43/hr

  • Medical

  • Life

  • Retirement

  • PTO

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 ...

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Showing results 1-20

All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Iowa

Remote Utilization Review Nurse information

See Iowa salary details

$20

$39

$64

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

As of Aug 19, 2026, the average hourly pay for remote utilization review nurse in Iowa is $39.71, according to ZipRecruiter salary data. Most workers in this role earn between $31.39 and $45.62 per hour, depending on experience, location, and employer.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse?

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

More about Remote Utilization Review Nurse jobs

What are the most commonly searched types of Utilization Review Nurse jobs in Iowa?

The most popular types of Utilization Review Nurse jobs in Iowa are:

What are popular job titles related to Remote Utilization Review Nurse jobs in Iowa?

For Remote Utilization Review Nurse jobs in Iowa, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Nurse jobs in Iowa look for?

The top searched job categories for Remote Utilization Review Nurse jobs in Iowa are:

What cities in Iowa are hiring for Remote Utilization Review Nurse jobs?

Cities in Iowa with the most Remote Utilization Review Nurse job openings:

Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Iowa as of August 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $82,605 per year, or $39.7 per hour.

Regional Reimbursement Nurse Consultant

Prestige Healthcare Management

West Des Moines, IA • Remote

$90K - $110K/yr

Full-time

Re-posted 18 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