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Remote Utilization Management Nurse Jobs in Springfield, IL

Consociate Health

Utilization Management Coordinator

IL · On-site +1

$23/hr

The Utilization Management Coordinator reports to the Director of Claims. This position is ... This is a fully remote position. * If work is performed offsite, location must be HIPAA compliant.

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Remote Utilization Management Nurse information

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$21

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$68

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

As of Jun 17, 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.
More about Remote Utilization Management Nurse jobs
What are popular job titles related to Remote Utilization Management Nurse jobs in Springfield, IL? For Remote Utilization Management Nurse jobs in Springfield, IL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Springfield, IL look for? The top searched job categories for Remote Utilization Management Nurse jobs in Springfield, IL are:
What cities near Springfield, IL are hiring for Remote Utilization Management Nurse jobs? Cities near Springfield, IL with the most Remote Utilization Management Nurse job openings:
Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Springfield, IL as of June 2026, with employment types broken down into 48% Full Time, 38% Part Time, 2% Temporary, and 12% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

Utilization Management Coordinator

Consociate Health

IL • On-site, Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

Job Description
Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.
As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.
Position Summary:
The Utilization Management Coordinator reports to the Director of Claims. This position is responsible for coordinating the appeal activities and UM process which includes initiating Case Management, requesting Pre-certification, submitting Medical Reviews, and Independent Dispute Resolution. The successful candidate(s) will bring the utmost level of service, professionalism, and commitment to this position.
Essential Duties and Responsibilities:
  • Gather, analyze, and report information regarding member and provider appeals.
  • Prepare and respond to written inquiries from employer, members, and providers in accordance with Department of Labor guidelines and applicable summary plan document language.
  • Maintain files and logs for all appeals.
  • Interface with various managed care organizations, UM, and cost containment Vendors to coordinate reviews for medical necessity including pre-determinations and retrospective reviews.
  • Review submissions by the Claims Department to determine appropriateness of services through established UM guidelines, triology, summary plan document review, etc.
  • Actively participate in meetings including presentation of reports, statistics, etc.
  • Perform other related duties and participate in special projects as assigned.

Benefits:
  • Paid time off
  • Paid Holidays
  • Medical, Dental and Vision Insurance
  • Basic Group Life, Short Term and Long Term Disability
  • Voluntary Life, Critical Illness and Accident Coverage
  • 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.

Experience and Skills
Knowledge, Skills and Abilities:
  • Strong administrative/technical skills; Comfortable working on a PC using Microsoft Office, Microsoft Teams, and telephones efficiently.
  • Excellent communication skills (spoken and written); comfortable talking on the phone for extended periods of time and replying to emails in a timely manner.
  • Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily.
  • Willingness to routinely, reliably come to work on schedule and adjust shift/scheduling based on the needs of the organization (including occasional paid overtime)
  • Education: High School Diploma or General Education Development (GED) equivalent.

General Expectations:
  • Always present a positive image of Consociate.
  • Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual.
  • Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
  • Identify and perform work that has not been specifically assigned, as needed
  • Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
  • Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
  • Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Client Services Division.
  • Attend required in-service and staff meetings.
  • Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees, and applicants.

Physical and Mental Abilities:
  • Ability to perform sedentary work for extended periods of time.
  • Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of team members.

  • Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Working Conditions:
  • This is a fully remote position.
  • If work is performed offsite, location must be HIPAA compliant.

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