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Remote Utilization Review Nurse 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 optimizing healthcare delivery by ensuring medical necessity and appropriate patient status throughout ...

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 ...

Aviary

$20 - $30/hr

Review patients progress, evaluating compliance and patient response to exercise * Lead group ... Work closely with a multidisciplinary team, including cardiologists, nurses, physical therapists ...

DaVita

... review patient cases,identifygaps/barriers, and coordinate on advance patient care plan ... Ability to work independently in a remote environment, managing a caseload of high-complexity ...

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Graduates from accredited Schools of Nursing (LPN, LVN, RN, BSN, etc.) * Current COMPACT license to ...

LRS Healthcare

Recruiter (Remote)

Omaha, NE · On-site +1

... and nursing healthcare professional across the nation. The Recruiter position is integral in ... For further information, please review the Know Your Rights notice from the Department of Labor.

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

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

As of Aug 30, 2026, the average hourly pay for remote utilization review nurse in Nebraska is $40.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.88 and $46.30 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.

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Nebraska as of August 2026, with employment types broken down into 4% As Needed, 84% Full Time, 8% Part Time, and 4% Contract. Highlights an 100% Remote job distribution, with an average salary of $83,852 per year, or $40.3 per hour.

Utilization Review RN

Omaha, NE • On-site, Remote

CHI Health
Health Care and Social Assistance • 10K+ employees

6.5

Company rating: 6.5 out of 10

Based on 130 frontline employees who took The Breakroom Quiz

611th of 895 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about CHI Healthexternal

$33.51 - $48.58/hr

Other

Posted 4 days ago

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

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