ZipRecruiter

Log In

2

Remote Optum Utilization Review Jobs in Springfield, IL

People also search for

All JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Springfield, IL

Remote Optum Utilization Review information

See Springfield, IL salary details

$21

$41

$68

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

As of Jun 11, 2026, the average hourly pay for remote optum utilization review in Springfield, IL is $41.91, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review position?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review Nurse, and why are they important?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What are popular job titles related to Remote Optum Utilization Review jobs in Springfield, IL? For Remote Optum Utilization Review jobs in Springfield, IL, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Springfield, IL look for? The top searched job categories for Remote Optum Utilization Review jobs in Springfield, IL are:
What cities near Springfield, IL are hiring for Remote Optum Utilization Review jobs? Cities near Springfield, IL with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you
Error Resolution Section Manager (SPSA)

Error Resolution Section Manager (SPSA)

State of Illinois

Springfield, IL • On-site, Remote

$10K - $12K/mo

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

State Of Illinois rating

7.8

Company rating: 7.8 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

20th of 50 rated states

Job description

Job Requisition ID: 56251 
BPIS: 10179

Opening Date: 06/02/2026
Closing Date: 06/16/2026
Agency:Department of Healthcare and Family Services
Class Title: SENIOR PUBLIC SERVICE ADMIN (40070) 
Skill Option: General Administration/Business Marketing/Labor/Personnel 
Bilingual Option: None
Salary: Anticipated starting salary: $10,500 - $12,500/mo
Job Type: Salaried
Category: Full Time 
County: Sangamon
Number of Vacancies: 1
Bargaining Unit Code: None
Merit Comp Code: Federally Funded, Gubernatorial (Management Bill) Exclusion from Collective Bargaining Coverage


A resume is highly encouraged to evaluate your qualifications and skills as part of your application.  Please attach a DETAILED Resume/Curriculum Vitae (CV) to the MY DOCUMENTS section of your application if you decide to provide one.

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, dedicated to improving lives for Illinoisans, is seeking to hire a highly motivated, qualified individual as a Senior Public Service Administrator who will serve as the Bureau of Claims Processing, Error Resolution Section Manager.  The ideal candidate will demonstrate an overall strong skill set that will ensure the Bureau of Claims Processing maintains the highest level of standards in all operations within the Bureau, particularly in processing medical claim documents for timely payments to the provider community, online correction and utilization review of provider submitted invoices for proper payment adjudication.  The ideal candidate will demonstrate their dedication to teamwork, the ability to work in a fast-paced, ever-changing environment, a strong supervisory background, including experience managing a large staff, knowledge of the Department’s goals and objectives, knowledge and experience managing large scale processing operations, and the desire to promote and provide quality services on behalf of the State of Illinois.  We invite qualified candidates to consider joining the Bureau of Claims Processing team to continue the overall mission of the Department of Healthcare and Family Services.

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
  • Subject to management approval, serves as the Error Resolution Section Manager by planning, developing, and managing the operations of the Error Resolution Section relating to the adjudication and maintenance of medical invoices submitted in accordance with the Medicaid Program, as well as the pricing and prepay processes, special processing of newborn invoices, online-correction processes of Institutional and non-institutional claims with or without attachments, including Medicare crossover claims
  • Serves as full line supervisor
  • Directs the operation of corrections processing for adjudication of medical invoices through the Department’s Medicaid Management Information System (MMIS), special processing of newborn invoices, processing of electronic claim submissions with and without attachments for all claim types, review and processing preparation of claims with attachments requiring review, including, but not limited to, hysterectomy and sterilization forms, general and post general mode reports, reject and aged document reports, on line correction processing of all hard copy and electronic claims types for institutional and non-institutional invoices with and without attachments, including Medicare Crossover invoices and the Pricing and Prepay utilization review processes
  • Directs the management of the Pricing/Prepay Unit, Special Program Review Unit, On-line Corrections Unit and Medicare unit on the integration of program activities to resolve administrative, policy and procedural issues
  • Consults with management on the integration of program activities
  • Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above
Minimum Qualifications
  • Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college
  • Requires prior experience equivalent to four (4) years of progressively responsible administrative experience in a public or business organization
Preferred Qualifications
  • Minimum of four (4) years of experience supervising professional staff in an office setting
  • Minimum of four (4) years of professional experience directing the processing of medical claims and payments for a public or private organization
  • Minimum of three (3) years of professional experience working with on-line claim processing and/or data claim processing
  • Minimum of three (3) years of professional experience developing and implementing program and operational policies and procedures
  • Minimum of three (3) years of professional experience researching and analyzing large sets of claims data
  • Minimum of three (3) years of professional experience communicating with stakeholders at all levels within an organization
  • Minimum of two (2) years of experience working with Microsoft Excel to maintain complex spreadsheets and track daily tasks 
  • Licensure in one of the following specialties: Registered Nurse, Licensed Practical Nurse, Speech/Language Pathologist, Respiratory Therapist, Physical Therapist or Occupational Therapist
  • Minimum of one (1) year of experience providing supporting documentation for deposition and/or testimony in a State or Federal court of law
Conditions of Employment
  • Requires completion of a background check and self-disclosure of criminal history
  • Requires the ability to travel in the performance of duties, with overnight stays as appropriate
  • Requires the ability to utilize and maintain state issued equipment such as a laptop
  • This position has been found to meet the requirements in section 4A-101 of the Illinois Governmental Ethics Act requiring the occupant/employee to file a Statement of Economic Interest. The Illinois Governmental Ethics Act (5 ILCS 420/4A et seq.) requires certain state officials and employees to file annual Statements of Economic Interest with the Office of the Secretary of State that will be made available for examination and copying by the public. All employees required to file a Statement of Economic Interest are also required to file the Supplemental Statement of Economic Interest with the Executive Ethics Commission. (See Executive Order 15-09) Fines and penalties apply to untimely filings
  • 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 am - 5:00 pm 
Headquarter Location: 201 S Grand Ave E, Springfield, Illinois, 62704 
Work County: Sangamon
Agency Contact: HFS.DMPApps@illinois.gov
Posting Group: Leadership & Management

Statement of Economic Interest:

This position has been found to meet the requirements in section 4A-101 of the Illinois Governmental Ethics Act requiring the occupant/employee to file a Statement of Economic Interest. The Illinois Governmental Ethics Act (5 ILCS 420/4A et seq.) requires certain state officials and employees to file annual Statements of Economic Interest with the Office of the Secretary of State that will be made available for examination and copying by the public. All employees required to file a Statement of Economic Interest are also required to file the Supplemental Statement of Economic Interest with the Executive Ethics Commission. (See Executive Order 15-09) Fines and penalties apply to untimely filings. 

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

Pay

Benefits

Hours and flexibility

Workplace

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

FacebookTwitter

View All State of Illinois Jobs

Apply