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Remote Utilization Review Nurse Jobs in Kansas (NOW HIRING)

Home State Health Plan

Medical Director

Kansas City, KS · On-site +1

$225K - $428K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Home State Health Plan

Medical Director

Kansas City, KS · On-site +1

$225K - $428K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Finite State

$99K - $100K/yr

Manages utilization across the team to balance billable engagement work, capability development ... review, and continuous learning; fosters psychological safety in a fully remote operating ...

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Remote Utilization Review Nurse information

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$19

$37

$61

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

As of Sep 8, 2026, the average hourly pay for remote utilization review nurse in Kansas is $37.71, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $43.32 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 Kansas?

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

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Cities in Kansas 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 Kansas as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $78,435 per year, or $37.7 per hour.

*New - Prior Authorization Specialist (Experience)- Remote

Nyx Health

Kansas City, KS • On-site, Remote

$21 - $23/hr

Full-time

Posted 3 days ago

New

Job description

Prior Authorization Specialist - Remote
Position Summary
We're looking for a driven, detail-oriented individual to join our team as a Prior Authorization Specialist. You'll receive training and ongoing support to set you up for success. As part of this role, you'll complete accurate insurance verifications and prior authorizations to ensure timely reimbursement. You'll also collaborate with clinicians and insurance payors in a fast-paced environment to manage claims, documentation, and approvals. If you enjoy problem-solving, staying organized, and making a meaningful impact-both independently and as part of a team-we'd love to hear from you.
Key Responsibilities
  • Pharmacy Benefits PA Submissions
  • Navigating EMR/PM systems for demographic information, patient clinical notes, and labs.
  • Coordinate initial submission of prior authorization processes including preparation of PA, answering Prior Authorization clinical questions, submitting Pharmacy benefit PA's
  • Utilize covermymeds to complete submission of Prior Authorizations
  • Communicate with providers and insurance companies regarding authorization status.
  • Maintain HIPAA compliance and support daily revenue cycle operations.
  • Aprima experience+

Skills & Qualifications
  • 3-5 years rheumatology medication PA experience is Required
  • Specialty Pharmacy experience - Required
  • 5+ years of prior authorization experience -Required
  • Knowledge of rheumatology medications and biosimilars -Required
  • Proficient in EMR systems, Covermymeds, ECW, NextGen Emrs
  • Strong communication, problem-solving, and organizational skills.
  • Detail-oriented, analytical, and able to multitask in a fast-paced environment.

Education & Experience
  • High School Diploma required; additional education in business or healthcare preferred.
  • Experience in prior authorization, utilization review, insurance verification, and EMR systems. [preferred]

Work Environment & Physical Requirements
  • Remote position
  • Prolonged computer use; ability to lift up to 15 lbs.

Job Type, Schedule & Compensation
  • Full-time, Monday-Friday, 8-hour day shift.
  • Pay: $21-$23 per hour, [With additional pay available for exceptional experience.]

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