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Remote Utilization Review Rn Jobs in St Louis, MO

Public Health Nurse

Saint Louis, MO · On-site +1

$27.37 - $30/hr

  • Medical

  • Life

  • Retirement

  • PTO

North Central Community Health Center - St Louis County, MO, MO Job Type: Full-Time Remote ... Requires licensure as a Registered Nurse by the State of Missouri * Cardiopulmonary Resuscitation ...

Manager, Care Management

Belleville, IL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Manager, Care Management

Belleville, IL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Manager, Care Management

Belleville, IL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Denials Specialist (Remote) Pay Rate: $22.47/hour Assignment Length: 6-12 months (with potential to ... Experience with denials, appeals, or utilization management * Background as a CNA, CMA, Radiology ...

Showing results 21-40

Remote Utilization Review Rn information

See St Louis, MO salary details

$20

$41

$67

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

As of Aug 17, 2026, the average hourly pay for remote utilization review rn in St. Louis, MO is $41.11, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 St. Louis, MO?

For Remote Utilization Review Rn jobs in St. Louis, MO, the most frequently searched job titles are:

What cities near St. Louis, MO are hiring for Remote Utilization Review Rn jobs?

Cities near St. Louis, MO with the most Remote Utilization Review Rn job openings:

Infographic showing various Remote Utilization Review Rn job openings in St. Louis, MO as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,504 per year, or $41.1 per hour.

Remote Sr. Director of Operations

MDS Solutions

Saint Louis, MO • Remote

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 2 days ago

New


Job description

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a full-time Senior Director of Operations.

Education:

•Required: Graduate of an accredited college or university with a bachelor's in nursing

Experience:

•Required: At least 5 years of clinical experience, with 3 or more years of experience with the RAI process

Licenses/Certificates:

•Required: Current and unrestricted RN license in state(s) assigned

•Required: RAC-CT certification upon hire or within 6 months of hire.

•Required: Valid driver license and car insurance as required by state law.

•Required: Other as required by federal, state and local standards

Other Requirements:

•Proficient knowledge of PDPM and State Case Mix Reimbursement payment systems.

•Proficient in CMS Five Star Quality Measures, and Quality RFeporting Program

•Strong knowledge in current Medicare and Managed Care requirements and federal, state, and local regulations that affect skilled clinical care delivery.

•Ability to work effectively with all persons and disciplines.

•Ability to clearly articulate the complexities of RAI assessments and care planning.

•Ability to monitor MDS Coordinators and CRS’s to identify areas for growth and provide mentorship for growth, while maintaining accountability for standard operating   

  procedures and client outcomes.

•Must possess strong customer service skills to coordinate service delivery, including attention to clients, sensitivity to issues, identification and resolution of issues to promote positive client outcomes. Initiative, innovation, 

  and creativity required.

•Must have dynamic presentation skills and superior communication skills.

•Must have critical thinking skills with the ability to make good decisions and exercise sound clinical and professional judgment, with proven knowledge of quality

  improvement concepts and processes.


The Senior Director of Operations provides leadership and oversight to assigned Directors, MDS Coordinators and Clinical Reimbursement Specialists while partnering with facility leadership to drive reimbursement optimization, quality improvement, regulatory compliance, and operational excellence. The role combines direct consulting services with leadership responsibilities to ensure clients achieve measurable and sustainable results.
The Senior Director serves as a strategic partner to clients by identifying opportunities for improvement, developing action plans, providing education, and ensuring consulting recommendations translate into sustainable results. This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.


About Us:

At Key Rehab, we’re shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We’re all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.

We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today’s healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.

Whether you’re looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you’re valued and supported every step of the way.

We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:

  • Competitive salaries with bonus opportunities
  • Ample opportunities for promotion, transfer, and advancement
  • Work that is meaningful, fulfilling, and provides high job satisfaction
  • Reasonable working hours promoting work-life balance
  • Continuing education (CE) opportunities for ongoing professional development
  • Generous paid time off
  • Comprehensive health, dental, and life insurance packages
  • 401K with discretionary matching
  • Mileage and licensure reimbursements
  • Flexible Spending Account (FSA) and Health Savings Account (HSA) options