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Remote Optum Utilization Review Jobs in Springfield, IL

All JobsOptum Utilization Review 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 Jul 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
Infographic showing various Remote Optum Utilization Review job openings in Springfield, IL as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, and 17% Part Time. Highlights an 91% Physical, and 9% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

Medicaid Business/QA Analyst

MSR Technology Group

Springfield, IL • Remote

Contractor

Re-posted 8 hours 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.