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Remote Utilization Review Rn Jobs in Mississippi

Varsity Tutors

NCLEX-RN Tutor

Starkville, MS · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Gulfport, MS · On-site +1

$57 - $69.50/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Perry Health Inc

$40/hr

Collaborate with the broader care team -- including RNs and Accountability Coaches -- to reinforce ... chart review time also counting toward this total. * Non-Clinical Pay: $30.00/hour flat rate for ...

DataAnnotation

Clinical Appeals Nurse

Jackson, MS · Remote

$50/hr

... Utilization Management. Benefits Full‐time or part‐time remote position Choose which projects you want to work on Flexible schedule Projects are paid hourly starting at $50+ per hour Bonuses ...

DataAnnotation

Health Information Analyst

Jackson, MS · Remote

$40/hr

... Registered Nurses. Therapists: Physical Therapists, Occupational Therapists, Speech-Language ... Benefits This is a full-time or part-time REMOTE position. You'll be able to choose which projects ...

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

As of May 29, 2026, the average hourly pay for remote utilization review rn in Mississippi is $40.04, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $46.01 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are popular job titles related to Remote Utilization Review Rn jobs in Mississippi? For Remote Utilization Review Rn jobs in Mississippi, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Mississippi look for? The top searched job categories for Remote Utilization Review Rn jobs in Mississippi are:
What cities in Mississippi are hiring for Remote Utilization Review Rn jobs? Cities in Mississippi with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Director, Healthcare Services - REMOTE

Director, Healthcare Services - REMOTE

Molina Healthcare

Southaven, MS • Remote

$88.45K - $168.98K/yr

Full-time

Posted 2 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

146th of 259 rated insurance

Job description

JOB DESCRIPTION

Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties


Directs and oversee one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs.
Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management.
Develops and promotes interdepartmental integration and collaboration to enhance clinical services.
Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues.
Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs.
Ensures monthly auditing occurs with appropriate follow-up.
Engages in clinical training activities and outcomes.
Develops and mentors direct reporting healthcare services leadership.
Local travel may be required (based upon state/contractual requirements).

Required Qualifications

At least 8 years of health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.

At least 3 years of health care management/leadership required.

Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

Experience working within applicable state, federal, and third-party regulations.

Ability to manage conflict and lead through change.

Operational and process improvement experience.

Ability to work cross-collaboratively across a highly matrixed organization.

Ability to prioritize and manage multiple deadlines.

Excellent organizational, problem-solving and critical-thinking skills.

Strong written and verbal communication skills.

Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications


Registered Nurse (RN). License must be active and unrestricted in state of practice.
Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Medicaid/Medicare population experience.
Clinical experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $88,453 - $168,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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