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Remote Utilization Review Rn Jobs in Nebraska (NOW HIRING)

Corvel

Telephonic Case Manager I

Omaha, NE · Remote

$63K - $95K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Corvel

Telephonic Case Manager I

Omaha, NE · Remote

$63K - $95K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Varsity Tutors

NCLEX-RN Tutor

Lincoln, NE · Remote

$18 - $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 ...

Varsity Tutors

NCLEX-RN Tutor

Omaha, NE · Remote

$18 - $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 ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Nebraska

Remote Utilization Review Rn information

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

As of Jul 25, 2026, the average hourly pay for remote utilization review rn 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 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 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 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 are popular job titles related to Remote Utilization Review Rn jobs in Nebraska? For Remote Utilization Review Rn jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Nebraska look for? The top searched job categories for Remote Utilization Review Rn jobs in Nebraska are:
What cities in Nebraska are hiring for Remote Utilization Review Rn jobs? Cities in Nebraska with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Nebraska as of July 2026, with employment types broken down into 82% Full Time, 13% Part Time, 1% Temporary, and 4% Contract. Highlights an 51% Physical, 4% Hybrid, and 45% Remote job distribution, with an average salary of $83,852 per year, or $40.3 per hour.
Utilization Specialist

Utilization Specialist

Lutheran Family Services

Lincoln, NE • On-site, Remote

Full-time

Posted 24 days ago

Job description

Utilization Specialist
Job Type
Full-Time
Position Summary:
  • The Utilization Specialist uses strong independent judgment to ensure access to medically necessary, high-quality behavioral health and community-based services across the agency. The Utilization Specialist ensures services align with medical necessity, reimbursement requirements, and regulatory standards, while supporting continuity of care, reducing denials, and promoting operational sustainability while maintaining a client-centered focus.
Job Duties:
  • Serve as a liaison between managed care organizations (MCOs), payers, and internal clinical and operational teams to support authorization, utilization management, and reimbursement processes.
  • Conduct utilization reviews to ensure services meet medical necessity criteria, payer requirements, and continued stay expectations.
  • Monitor authorizations, service units, length of stay, and extensions; proactively communicate issues that may impact service delivery or reimbursement.
  • Coordinate pre-certifications and authorization requirements prior to service initiation in collaboration with admissions and intake staff.
  • Initiate and manage appeals for denied services or continued stay determinations, including facilitating peer-to-peer reviews as needed.
  • Review clinical documentation within the electronic health record to ensure accuracy, timeliness, and alignment with authorization and payer requirements.
  • Identify documentation gaps or compliance risks and provide guidance to staff on documentation standards and workflows.
  • Conduct quality and utilization reviews to assess appropriateness of services and compliance with payer and regulatory standards.
  • Monitor and report on non-certified days, denials, and utilization trends, including identifying root causes and opportunities for improvement.
  • Assist with internal, payer, and regulatory audits, including documentation review and response to data requests.
  • Develop and analyze utilization reports and metrics to support operational and clinical decision-making.
  • Provide training and ongoing education to staff on documentation standards, medical necessity, and utilization processes.
  • Serve as a resource for staff questions related to utilization management, documentation, and payer expectations.
  • Perform other duties as assigned to support program operations and organizational needs.
Required Skills/Abilities:
  • Expertise in utilization management, medical necessity, and managed care processes.
  • Strong written and verbal communication skills, with the ability to collaborate effectively across clinical, operational, and external stakeholders.
  • High attention to detail with strong organizational, analytical, and follow-through skills.
  • Proficiency in electronic health records and data tracking/reporting systems.
  • Able to analyze data, identify trends, and support process improvement efforts.
  • Commitment to confidentiality, ethical practice, and client-centered care.
  • Awareness and sensitivity of our constituents and the populations served by employees.
  • Regular and predictable attendance, and promptness for work.
  • Commitment to uphold the mission, vision, and values of Lutheran Family Services.
  • Support the organization’s objective to be an inclusive and accessible workplace.
Position Competencies:
  • Process Improvement
  • Relationship Building
  • Analytical Skills
  • Accountability
  • Communication Skills
Education and Experience:
  • High school diploma or equivalent required; bachelor’s degree in social work, behavioral health, nursing or related healthcare field preferred.
  • Two (2) years’ experience working with populations served by LFS or in a related clinical or behavioral health setting required.
  • Utilization Review experience highly preferred.
  • Experience in community mental health, CCBHC, or nonprofit human services preferred.
  • Active LPN, RN, MSW, CSW, LPC, or another clinical license in Nebraska preferred.
Physical Requirements:
  • Prolonged periods of sitting and working on a computer.
  • Hybrid or remote work may be available based on operational needs.
  • Flexible scheduling required during audits, appeal deadlines, or high-volume authorization periods.
  • Company-issued laptop and cell phone.
  • Valid driver’s license, liability auto insurance, and ability to drive a personal vehicle for travel between office locations and/or program sites, as needed.
Lutheran Family Services is an equal opportunity employer. We do not discriminate against any employee or applicant for employment on the basis of age, race, religion, color, ethnicity, disability, gender, sexual orientation, gender identity, or national origin.

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