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Remote Utilization Management Nurse Jobs in Springfield, IL

Humana

Manager, Care Management

Springfield, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Springfield, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Springfield, IL · Remote

Become a part of our caring community The Manager, Care Management leads teams of nurses, social ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Intuit

Implementation Consultant

Springfield, IL · Remote

$36.50 - $49.50/hr

Successfully manage and prioritize multiple complex customer implementations and engagements ... Sacramento $36.5 - $49.5 Colorado Remote $129,000- $174,000 Hawaii Remote $135,000- $183,000 ...

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Remote Utilization Management Nurse information

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How much do remote utilization management nurse jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for remote utilization management nurse 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 Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

What is a Remote Utilization Management Nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What Does a Remote Utilization Management Nurse Do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

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

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by Remote Utilization Management Nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.
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Consulting Principal- Program Director, Healthcare (Payer)

Consulting Principal- Program Director, Healthcare (Payer)

Cognizant

Springfield, IL • Remote

$122K - $194K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Cognizant rating

7.4

Company rating: 7.4 out of 10

Based on 85 frontline employees who took The Breakroom Quiz

41st of 58 rated business consultants

Job description

About Cognizant Consulting

Cognizant Consulting is more than Cognizant’s consulting practice—we’re a global community of 5,000+ experts dedicated to helping clients reimagine their business. Blending deep industry expertise with leading technology capabilities, we create innovative solutions for Fortune 500 clients.

Now, we’re looking for our next leader to help shape the future of healthcare transformation.

About the Role

As a Consulting Principal: Program Director – Healthcare Payer Transformation, you will make an impact by leading complex, enterprise-wide transformation programs across healthcare payer organizations.

You will be a valued member of the Healthcare Consulting team, working closely with senior client stakeholders, business and technology leaders, and cross-functional teams to deliver integrated transformation outcomes.

In this role, you will:

  • Lead large-scale healthcare transformation programs across claims, provider, member, billing, and operational domains, driving strategy through execution.

  • Define and execute program roadmaps and governance models, ensuring alignment across business, IT, operations, and external partners.

  • Serve as a functional leader across payer operations, translating business requirements into scalable operating models and transformation strategies.

  • Drive cross-layer integration, connecting business processes, applications, data flows, APIs, and vendor solutions to ensure end-to-end delivery integrity.

  • Engage executive stakeholders and lead governance forums, steering decision-making, managing vendor performance, and ensuring program success across multiple workstreams.

Work Model

We strive to provide flexibility wherever possible. Based on this role’s business requirements, this is a remote position open to qualified applicants in the United States with some travel involved.

Regardless of your working arrangement, we are here to support a healthy work-life balance through our wellbeing programs.

What you must have to be considered:

  • 12+ years of experience leading large-scale healthcare payer transformation programs

  • Deep functional expertise in payer operations (claims, provider, benefits, enrollment, utilization management)

  • Proven experience driving enterprise transformation programs across multi-vendor and multi-system environments

  • Strong understanding of enterprise integration, data flows, and cross-functional impacts across systems and operations

  • Demonstrated ability to lead complex, matrixed teams and influence senior stakeholders

  • Exceptional communication skills with strong executive presence and stakeholder management capabilities

These will help you succeed:

  • Experience leading national or multi-plan healthcare programs

  • Exposure to payer core platforms such as FACETS, QNXT, HealthEdge, or similar

  • Experience in digital transformation, modernization, or cloud initiatives

  • Certifications such as PMP, SAFe, or equivalent

Compensation

$122,400-$194,000

This position is eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.

Benefits

  • Medical, dental, vision, and life insurance

  • 401(k) plan and contributions

  • Employee stock purchase plan

  • Employee assistance program

  • 10 paid holidays plus PTO

  • Paid parental leave and fertility assistance

  • Learning and development certifications and programs

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

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