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Remote Clinical Reviewer Jobs in Springfield, IL

Clarvida

Clinical Supervisor

Springfield, IL · On-site +1

$68K/yr

You will also review client charts to ensure quality service delivery and accurate treatment plans ... Potential to transition to a more remote setting over time. Does the following apply to you?

Clarvida - Illinois

Clinical Supervisor

Springfield, IL · On-site +1

$68K/yr

You will also review client charts to ensure quality service delivery and accurate treatment plans ... Potential to transition to a more remote setting over time. Does the following apply to you?

Clarvida - Illinois

Clinical Supervisor

Springfield, IL · On-site +1

$68K/yr

You will also review client charts to ensure quality service delivery and accurate treatment plans ... Potential to transition to a more remote setting over time. Does the following apply to you?

Revvity

Contracts Coordinator

Springfield, IL · On-site +1

$62K - $75K/yr

This position is available for remote or hybrid at our Hopkinton, MA location. The Contracts ... Reviewing, analyzing and preparing Requests for Proposals (RFPs), Requests for Information (RFIs ...

Adecco

Pharmacist Pipeline Springfield IL

Springfield, IL · On-site +1

$58 - $60/hr

Adecco Healthcare & Life Sciences is hiring remote pharmacists! For this role you must reside ... Primary Responsibilities: · Serve as a clinical resource working from a computer, reviewing prior ...

All JobsClinical Reviewer JobsRemote Clinical Reviewer JobsRemote Clinical Reviewer Jobs in Springfield, IL

Remote Clinical Reviewer information

See Springfield, IL salary details

$24

$35

$45

How much do remote clinical reviewer jobs pay per hour?

As of Jul 28, 2026, the average hourly pay for remote clinical reviewer in Springfield, IL is $35.60, according to ZipRecruiter salary data. Most workers in this role earn between $30.96 and $40.05 per hour, depending on experience, location, and employer.

What are Remote Clinical Reviewers?

Remote Clinical Reviewers are healthcare professionals, often nurses or physicians, who evaluate medical records and treatment plans from a remote location to ensure they meet clinical guidelines and insurance requirements. They assess the necessity, appropriateness, and quality of care provided to patients, often working for insurance companies, healthcare organizations, or third-party review agencies. This role typically involves reviewing documentation, making recommendations, and communicating findings electronically or by phone. The position allows for flexible, home-based work while contributing to healthcare quality and compliance.

What is the difference between Remote Clinical Reviewer vs Remote Medical Reviewer?

AspectRemote Clinical ReviewerRemote Medical Reviewer
Required CredentialsRN, LPN, or other healthcare licenses; clinical experienceMD or DO license; medical degree; clinical experience
Work EnvironmentHome-based, healthcare organizations, insurance companiesHome-based, insurance companies, healthcare organizations
Employer & Industry UsageInsurance, healthcare providers, government programsInsurance, healthcare, legal medical review
Common Search & ComparisonYesYes

Remote Clinical Reviewers typically hold nursing or healthcare licenses and focus on reviewing clinical documentation and patient care. Remote Medical Reviewers usually have medical degrees and perform in-depth medical assessments, often for insurance claims or legal cases. Both roles are home-based and serve similar industries, but the Medical Reviewer requires a medical degree and broader clinical expertise.

How does a Remote Clinical Reviewer typically collaborate with other healthcare professionals while working offsite?

Remote Clinical Reviewers regularly coordinate with physicians, nurses, and case managers through secure digital platforms, such as video conferencing, email, and electronic health record systems. Despite working remotely, they are integral to interdisciplinary teams and often participate in virtual meetings to discuss patient cases, clarify documentation, and ensure compliance with clinical guidelines. Building strong communication skills and familiarity with collaboration tools is essential for success in this role, as frequent interaction with both internal teams and external providers is a common aspect of daily responsibilities.

What are the key skills and qualifications needed to thrive as a Remote Clinical Reviewer, and why are they important?

To thrive as a Remote Clinical Reviewer, you need a healthcare background such as RN, LPN, or other clinical licensure, along with strong knowledge of medical guidelines and utilization review processes. Familiarity with electronic medical record (EMR) systems, medical coding, and utilization management software is typically required. Attention to detail, analytical thinking, and clear written communication are crucial soft skills for reviewing patient cases and collaborating with remote teams. These skills and qualifications ensure accurate and timely clinical assessments, support compliance, and help facilitate appropriate patient care decisions in a virtual environment.

What Does a Remote Clinical Reviewer Do?

A remote clinical reviewer works from home reviewing medical records and claims for inpatient and outpatient services. Your responsibilities include executing a thorough review of patient medical records, submitting documentation to insurance companies, and ensuring accurate, timely, and secure processing of patient information. As a clinical reviewer, your duties span determining coverage for diagnosis and treatment, reviewing appeals, and processing correspondence. You provide remote support and expertise to department care coordinators, interact with teams and department heads as necessary, and request additional information for processing records as necessary.

More about Remote Clinical Reviewer jobs
What are popular job titles related to Remote Clinical Reviewer jobs in Springfield, IL? For Remote Clinical Reviewer jobs in Springfield, IL, the most frequently searched job titles are:
What job categories do people searching Remote Clinical Reviewer jobs in Springfield, IL look for? The top searched job categories for Remote Clinical Reviewer jobs in Springfield, IL are:
What cities near Springfield, IL are hiring for Remote Clinical Reviewer jobs? Cities near Springfield, IL with the most Remote Clinical Reviewer job openings:
Remote Clinical Reviewer jobs near you
Infographic showing various Remote Clinical Reviewer job openings in Springfield, IL as of July 2026, with employment types broken down into 75% Full Time, and 25% Contract. Highlights an 100% Remote job distribution, with an average salary of $74,043 per year, or $35.6 per hour.
Prior Approval Reviewer (Physician)

Prior Approval Reviewer (Physician)

State of Illinois

Springfield, IL • On-site, Remote

$13K - $17K/mo

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

State Of Illinois rating

7.9

Company rating: 7.9 out of 10

Based on 74 frontline employees who took The Breakroom Quiz

13th of 50 rated states

Job description

Job Requisition ID: 57241 

BPIS: 08199
Opening Date: 07/08/2026
Closing Date: 07/22/2026
Agency: Department of Healthcare and Family Services
Class Title: PHYSICIAN - 32200 
Skill Option: None 
Bilingual Option: None
Salary: Anticipated starting salary $13,138/monthly; Full salary range $13,138-17,872/monthly
Job Type: Salaried
Category: Full Time 
County: Sangamon
Number of Vacancies: 1
Bargaining Unit Code: RC063 Professional Employees, Educators,Juvenile Justice School Counselors and Special Education Resources Coordinators,and Physicians AFSCME
Merit Comp Code: 

This position is a union position; therefore, provisions of the relevant collective bargaining agreement/labor contract apply to the filling of this position.

All applicants who want to be considered for this position MUST apply electronically through the illinois.jobs2web.com website. State of Illinois employees should click the link near the top left to apply through the SuccessFactors employee career portal.

Applications submitted via email or any paper manner (mail, fax, hand delivery) will not be considered.

 

 

Why Work for Illinois?

Working with the State of Illinois is a testament to the values of compassion, equity, and dedication that define our state. Whether you're helping to improve schools, protect our natural resources, or support families in need, you're part of something bigger-something that touches the lives of every person who calls Illinois home.

No matter what state career you're looking for, we offer jobs that fit your life and your schedule-flexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.

Position Overview:

The Department of Healthcare and Family Services, Bureau of Professional and Ancillary Services is seeking to hire a motivated candidate to serve as a Prior Approval Reviewer. Under the direction of the Prior Approval and Customer Relations section manager, this position will serve as a specialized physician reviewer for the Medical Review Unit. The duties for this position may include but are not limited to; providing expert medical/clinical, consultative, program and policy advisory services related to specialized medical equipment and services  to staff, convening regular meetings with staff to participate in developing, implementing and maintaining system changes or policy decisions that may impact medical services to individuals eligible for Medical Assistance, and participate in developing medical criteria options for program coverage of durable medical equipment, supplies and other covered services.

The ideal candidate will have strong communication skills, excellent team leadership skills, ability to thrive in a high volume and fast paced environment and demonstrate the ability to collaborate with team members to ensure operations are running effectively.

HFS values employees with different backgrounds, life experiences, and talents. HFS values employees with different backgrounds, life experiences, and talents. 

Employees receive a robust benefit package including:

  • Monday-Friday work schedule
  • Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.)
  • Health, Life, Vision, and Dental Insurance
  • Pension Plan
  • Paid Parental Leave
  • Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
  • Employees earn (12) paid Sick Days annually.
  • New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
  • Employees earn (3) paid Personal Days annually.
  • (13-14) paid holidays annually (based on start date)

If you are seeking a new opportunity, and this position appeals to you, please apply today!

At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained.

HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion.  We welcome and value employees with different backgrounds, life experiences, and talents.  It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement.  In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.

Essential Functions
  • Serves as a Prior Approval Reviewer for the Bureau of Professional & Ancillary Services/Prior Approval &
    Customer Relations Section/Medical Review Unit
  • Conducts clinically based research on new technology and medical advancements related to specialized medical
    equipment and services and makes recommendations on modifications to current policy and expansion of program
    coverage
  • Conducts clinical analysis of medical procedures and diagnosis coding changes
  • Provides expert testimony on behalf of the department, including, but not limited to, fraud and abuse cases and
    participant appeals on denials of coverage
  • Stays abreast of new techniques and procedures in the clinical/medical field
  • Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated
    above
Minimum Qualifications
  • Requires an Illinois license to practice medicine
Specialized Skills
  • A minimum of two (2) years of experience making clinical prior approval decisions including, working with complex medical data, and familiarity with medical coding such as ICD-10CM, CPT or HCPCSs
  • A minimum of two (2) years of professional experience communicating with medical providers on behalf of a payer
    regarding billing codes and rejection codes as well as medical terminology
  • Requires two (2) years of experience working with Medical Management Information Systems (MMIS) or similar medical processing system
Preferred Qualifications
  • A minimum of two (2) years of experience making clinical prior approval decisions including, working with complex medical data, and familiarity with medical coding such as ICD-10CM, CPT or HCPCSs
  • A minimum of two (2) years of professional experience communicating with medical providers on behalf of a payer regarding billing codes and rejection codes as well as medical terminology
  • A minimum of two (2) years of experience working with Medical Management Information Systems (MMIS) or similar medical processing system
  • A minimum of two (2) years of experience utilizing the basic principles and practices of general medicine and surgery, including the diagnosis and treatment of diseases and inquiries
  • A minimum of two (2) years of experience conducting research regarding recent changes to technology or accepted procedures in the field of general medicine to recommend modifications to policies
  • A minimum of two (2) years of experience evaluating the quality of medical care and treatment for a medical or social services organization
  • A minimum of two (2) years of experience performing reviews of medical data and determining medical needs for a medical or social service organization
  • A minimum of two (2) years of experience preparing detailed and accurate medical documentation to support any medical review determination
Conditions of Employment
  • Requires completion of a background check and self-disclosure of criminal history
  • Requires the ability to utilize and maintain state issued equipment such as a laptop
  • Requires ability to attend seminars, conferences, and trainings to stay current on methods, tools, ideologies, or other industry related topics relevant to the job duties
  • The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job
    description

Work Hours: Monday - Friday 8:30 a.m. - 5:00 p.m.
Headquarter Location: 201 S Grand Ave E, Springfield, Illinois, 62704
Work County: Sangamon
Email: HFS.DMPApps@illinois.gov
Posting Group: Health Services

This position DOES contain "Specialized Skills" (as that term is used in CBAs).

APPLICATION INSTRUCTIONS

Use the "Apply" button at the top right or bottom right of this posting to begin the application process.

If you are not already signed in, you will be prompted to do so. 

State employees should sign in to the career portal for State of Illinois employees - a link is available at the top left of the Illinois.jobs2web.com homepage in the blue ribbon. 

Non-State employees should log in on the using the "View Profile" link in the top right of the Illinois.jobs2web.com homepage in the blue ribbon.  If you have never before signed in, you will be prompted to create an account.

If you have questions about how to apply, please see the following resources:

State employees: Log in to the career portal for State employees and review the Internal Candidate Application Job Aid

Non-State employees: on Illinois.jobs2web.com - click "Application Procedures" in the footer of every page of the website.

The main form of communication will be through email. Please check your "junk mail", "spam", or "other" folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:

  • donotreply@SIL-P1.ns2cloud.com
  • systems@SIL-P1.ns2cloud.com

What State Of Illinois employees say

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Hours and flexibility

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Get the full story on Breakroom

State of Illinois logo

About State of Illinois

Sourced by ZipRecruiter

The State of Illinois is not a traditional company, but rather a governmental entity encompassing diverse agencies and departments that serve the constituents of Illinois. Based in Illinois, United States, this governmental body communicates with its citizens through the official website illinois.gov. The website is a one-stop resource for Illinois residents to access information about the state's services, including education, healthcare, transportation, and public safety, among others.

Company size

11 - 50 Employees

Headquarters location

Springfield, IL, US

Year founded

2009

Social media

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