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Remote Occupational Therapy Utilization Review Jobs in Springfield, IL

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Remote Occupational Therapy Utilization Review information

See Springfield, IL salary details

$23

$44

$66

How much do remote occupational therapy utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for remote occupational therapy utilization review in Springfield, IL is $44.97, according to ZipRecruiter salary data. Most workers in this role earn between $38.37 and $50.53 per hour, depending on experience, location, and employer.

What is a remote occupational therapy utilization review?

A Remote Occupational Therapy Utilization Review job involves evaluating occupational therapy treatment plans and medical records to ensure they meet insurance guidelines and medical necessity. Professionals in this role work remotely to review documentation, provide recommendations, and collaborate with healthcare providers and insurance companies. Their main goal is to ensure appropriate care while preventing unnecessary costs. Strong analytical skills and knowledge of occupational therapy practices and insurance regulations are essential for this role.

What does a remote occupational therapy utilization review do?

Professionals in Remote Occupational Therapy Utilization Review primarily review clinical documentation to determine the medical necessity and appropriateness of occupational therapy services. Typical daily tasks include analyzing therapy notes, applying payer criteria to case reviews, communicating with providers for clarifications, and documenting decisions within electronic systems. You may also participate in team meetings, provide feedback to therapy staff, and stay updated on changing regulations or insurance policies. This role requires a balance of independent work and frequent collaboration with other utilization reviewers, case managers, and healthcare providers to ensure the highest quality of care and compliance.

What are the key skills and qualifications needed to thrive in remote occupational therapy utilization review?

To thrive as a Remote Occupational Therapy Utilization Review professional, you need a background in occupational therapy, solid clinical assessment skills, and familiarity with medical necessity criteria such as Medicare or insurance guidelines. Experience using electronic medical record (EMR) systems, utilization review software, and knowledge of relevant certifications like OTR/L or CHT are typically required. Attention to detail, critical thinking, and strong written communication skills are highly valued in this role. These abilities are crucial to making accurate determinations, maintaining compliance, and effectively collaborating with healthcare teams and insurers from a remote setting.

What are the most commonly searched types of Occupational Therapy Utilization Review jobs in Springfield, IL?

The most popular types of Occupational Therapy Utilization Review jobs in Springfield, IL are:

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For Remote Occupational Therapy Utilization Review jobs in Springfield, IL, the most frequently searched job titles are:

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The top searched job categories for Remote Occupational Therapy Utilization Review jobs in Springfield, IL are:

What cities near Springfield, IL are hiring for Remote Occupational Therapy Utilization Review jobs?

Cities near Springfield, IL with the most Remote Occupational Therapy Utilization Review job openings:

Remote Occupational Therapy Utilization Review jobs near you
Infographic showing various Remote Occupational Therapy Utilization Review job openings in Springfield, IL as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 20% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $93,535 per year, or $45 per hour.

Medicaid Business/QA Analyst

MSR Technology Group

Springfield, IL • Remote

Contractor

Re-posted 7 days ago

Job description

Medicaid Business / QA Analyst
  • 7–12+ Month Contract | Remote | No ThirdParty Firms | Medicaid SME Required
  • Candidates with previous State Medicaid program experience will be given strong consideration.
  • Drug screen and background check required as part of onboarding
Position Summary
The Medicaid Business/QA Analyst serves as a subject matter expert (SME) for Medicaid data and processes while performing quality assurance testing within a large-scale Enterprise Data Warehouse (EDW) environment. This position combines program knowledge—eligibility, claims, encounters, provider enrollment, managed care, and reporting—with QA discipline to ensure accuracy, completeness, and usability of EDW deliverables such as data marts, inbound source data loads, outbound extracts, reporting outputs, and operational dashboards.
Key Responsibilities1. Business SME – Medicaid Data & Processes
  • Interpret Medicaid data elements, business rules, and program logic for EDW initiatives.
  • Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy and mapping alignment.
  • Validate outbound extracts and reporting outputs for accuracy, timeliness, and format requirements.
  • Support development of data marts across eligibility, claims/utilization, provider, managed care, LTSS, and behavioral health.
2. QA Planning & Execution
  • Develop QA plans, scenarios, and test cases aligned to business rules.
  • Perform data reconciliation between source files and EDW target tables.
  • Validate transformations, aggregations, and derived fields.
  • Participate in User Acceptance Testing (UAT) with business stakeholders.
3. Data Quality & Issue Resolution
  • Identify data anomalies, mapping issues, and business rule gaps; work with data engineering and ETL teams to resolve.
  • Ensure referential integrity across eligibility, claims, provider, and plan datasets.
  • Define business data quality rules for ongoing monitoring.
  • Track and document issues in defect management tools.
4. Collaboration & Documentation
  • Work with business stakeholders, vendors, and technical teams to validate requirements and deliverables.
  • Review BRDs, mapping documentation, and data models for accuracy.
  • Maintain QA evidence, testing documentation, and business rule records.
  • Support knowledge transfer related to Medicaid data usage within the EDW.
Required Skills & Qualifications
  • Strong Medicaid business knowledge (eligibility, claims, encounters, provider, managed care).
  • Experience working with EDW environments, including inbound feeds, staging layers, integration layers, data marts, and outbound extracts.
  • Proficiency with SQL for validation and reconciliation.
  • Experience in data warehouse QA/testing, including validating data transformations and dimensional models.
  • Ability to translate Medicaid program rules into testable acceptance criteria.
  • Familiarity with HIPAA compliance and PHI guidelines.
  • Excellent analytical, documentation, and communication skills.
Preferred Qualifications
  • Experience with Medicaid EDW or MMIS modernization projects.
  • Familiarity with provider handbooks, policy documentation, or administrative rules.
  • Experience with managed care data (capitation, encounters, member assignments).
  • Experience validating dashboards or reports in tools such as Tableau, Power BI, or Cognos.
  • Background in data governance or metadata management.