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Remote Utilization Review Rn Jobs in Omaha, NE (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

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 ...

Mutual of Omaha

VP & Medical Director

Omaha, NE · On-site +1

$201K - $320K/yr

Remote Categories: Underwriting, Leadership As our VP & Medical Director, you'll shape medical ... Provide strategic direction for medical review activities, including utilization review, fraud ...

Gentell

Certified Wound Care Clinician/Nurse

Omaha, NE · On-site +1

... utilization of wound care products - Understanding Medicare documentation and reimbursement ... (RN, LPN, PT, OTR-L, DPM or similar) preferred but could be certified in the first year of hire ...

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Remote Utilization Review Rn information

See Omaha, NE salary details

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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 Omaha, NE is $38.88, according to ZipRecruiter salary data. Most workers in this role earn between $30.72 and $44.66 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 Omaha, NE? For Remote Utilization Review Rn jobs in Omaha, NE, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Omaha, NE look for? The top searched job categories for Remote Utilization Review Rn jobs in Omaha, NE are:
What cities near Omaha, NE are hiring for Remote Utilization Review Rn jobs? Cities near Omaha, NE 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 Omaha, NE as of July 2026, with employment types broken down into 90% Full Time, 7% Part Time, and 3% Contract. Highlights an 51% Physical, 4% Hybrid, and 45% Remote job distribution, with an average salary of $80,867 per year, or $38.9 per hour.

Regional Reimbursement Nurse Consultant

Prestige Healthcare Management

Omaha, NE • Remote

$90K - $110K/yr

Full-time

Posted 13 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