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Remote Utilization Review Manager Jobs in DeKalb, IL

AltaStaff, LLC

Care Review Clinician

Cherry Valley, IL · Remote

$40 - $42/hr

This is a fully remote role but candidates must have a valid RN license in Illinois*** Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for ...

Tailored Management

US_Strategic Consultant I

Rockford, IL · Remote

$63 - $70/hr

Marketing Operations Resource Manager Location: Remote ( EST Preferred) Duration: 6-month contract ... Facilitate vendor Quarterly Business Reviews (QBRs) and performance reporting. * Manage print and ...

Harris

Remote Care Management - CMA

Oregon, IL · Remote

Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Our program offers a customized model of remote care services that blends Chronic Care Management ...

Tailored Management

US_Strategic Consultant I

Aurora, IL · Remote

$63 - $70/hr

Marketing Operations Resource Manager Location: Remote ( EST Preferred) Duration: 6-month contract ... Facilitate vendor Quarterly Business Reviews (QBRs) and performance reporting. * Manage print and ...

Cayenta

(Remote) Application Consultant

Oregon, IL · Remote

Work with colleagues and managers to implement and proactively manage superior utility CIS ... reviews and documentation, and requirements elicitation, allowing the project team to gain a ...

Beacon Talent

Remote Psychiatrist

Aurora, IL · Remote

$150 - $200/hr

The work is primarily diagnostic evaluation and ongoing medication management for an adult ... Document within our behavioral health EMR to the standard required for payer review * Escalate ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in DeKalb, IL

Remote Utilization Review Manager information

See DeKalb, IL salary details

$38.3K

$89.3K

$164.4K

How much do remote utilization review manager jobs pay per year?

As of Aug 26, 2026, the average yearly pay for remote utilization review manager in DeKalb, IL is $89,327.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,400.00 and $107,500.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are popular job titles related to Remote Utilization Review Manager jobs in DeKalb, IL?

For Remote Utilization Review Manager jobs in DeKalb, IL, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in DeKalb, IL look for?

The top searched job categories for Remote Utilization Review Manager jobs in DeKalb, IL are:

What cities near DeKalb, IL are hiring for Remote Utilization Review Manager jobs?

Cities near DeKalb, IL with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Care Review Clinician

AltaStaff, LLC

Cherry Valley, IL • Remote

$40 - $42/hr

Full-time

Posted 7 days ago

Job description

AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client!

Pay Rate: $40 - 42.00 hourly

Schedule: Monday-Friday 9am-5:30pm CST, Rotating Saturday 7-11am CST, Rotating Holidays

***This is a fully remote role but candidates must have a valid RN license in Illinois***

Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care.

  • Assess and analyze clinical service requests (e.g., surgeries, outpatient therapies, DME) using evidence-based MCP/MCG criteria.

  • Verify member benefits and eligibility and Process prior authorization determinations within regulatory timelines

  • Collaborate with multidisciplinary teams

  • Completes/reviews Authorizations, reviewing faxes that can be 50-100 pages long

  • Will be expected to manage 25-30 cases successfully daily.

  • Should be able to quickly and accurately determine whether the criteria meet medical necessity.

  • Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

  • Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and

  • guidelines.

  • Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

  • Additional duties assigned

Education/Experience: 

  • RN license in IL required

  • Must have 2+ years clinical practice experience (hospital, case management, utilization management)

  • Must have 1-3+ years of hospital or medical clinic, utilization review

  • Must have 2-3 years of Prior Authorization OR Med-Surg experience; Familiarity with Inpatient Medical Necessity

  • Must have solid experience within a clinical setting as RN’s must be able to use their knowledge to extrapolate key information during the authorization process

If you've applied and would like to view your application status, please visit: https://altastaff.zenople.com/login/ALTA

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

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