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Remote Utilization Review Manager Jobs in DeKalb, IL

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 ...

CSAA

Marketing Engagement Partner - Remote

Oregon, IL · Remote

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

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 ...

Harris

(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 ...

micro1 AI

Managing Partner - Attorney - Remote

Elgin, IL · Remote

$140 - $400/hr

Remote micro1 is engaging lawyers to contribute their subject-matter expertise in support of a ... Draft, review, and edit legal content, including memoranda, opinions, contracts, and other relevant ...

New

micro1 AI

Managing Partner - Attorney - Remote

Rockford, IL · Remote

$140 - $400/hr

Remote micro1 is engaging lawyers to contribute their subject-matter expertise in support of a ... Draft, review, and edit legal content, including memoranda, opinions, contracts, and other relevant ...

New

micro1 AI

Managing Partner - Attorney - Remote

Aurora, IL · Remote

$140 - $400/hr

Remote micro1 is engaging lawyers to contribute their subject-matter expertise in support of a ... Draft, review, and edit legal content, including memoranda, opinions, contracts, and other relevant ...

New

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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 3, 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 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 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 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

Utilization Review & Quality Assurance Specialist (32449)

ExamWorks LLC

Rockford, IL • On-site, Remote

$45 - $52/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

ExamWorks rating

8.0

Company rating: 8.0 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

Job description

Are you passionate about clinical quality, accuracy, and continuous improvement -and looking for a role that allows you to make a meaningful impact while working from home?
We're seeking a Utilization Review & Quality Assurance Specialist to join our fully remote team. This role offers a consistent 8:00am-4:30pm EST schedule, providing structure and work-life balance while you contribute to high-quality clinical review operations.
In this role, you'll be at the center of ensuring excellence - leveraging strong knowledge of group health plans, clinical criteria sets, leadership, and change management to review clinical documentation, uphold regulatory and client standards, and drive quality across medical review processes.
Responsibilities may include:
  • Evaluate clinical information received, write and/or review various reports including, but not limited to: Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements.
  • Perform quality assurance reviews of peer review reports, correspondences, addendums or supplemental reviews to ensure they meet company standards for content, clarity, evidence-based rationale, formatting, and professional presentation.
  • Ensure all client instructions and specifications have been followed, all questions have been answered, and all recommendations or determinations are supported by clear, concise, and evidence-based rationales.
  • Verify that each review includes appropriate clinical citations when applicable, and ensure all references cited are current and obtained from reputable medical journals and publications.
  • Identify inconsistencies within reports and contact the reviewer to obtain clarifications, modifications, or corrections needed.
  • Assist in the resolution of customer complaints and quality assurance issues as appropriate.
  • Ensure all federal ERISA and applicable state mandates are adhered to.
  • Provide ongoing feedback and recommendations to management regarding consultant performance, quality trends, and compliance with internal and client specific requirements.
  • Participate in the development and implementation of policies and procedures to improve efficiency and quality across operations.
  • Develop and lead formal and informal training sessions -individually or in groups -that promote high-quality utilization review practices and reinforce company standards.
  • Develop and document new or improved operational processes to support continuous improvement.
  • Promote effective and efficient utilization of company resources across all responsibilities.
  • Participate in or lead various continuing education and training activities related to clinical knowledge, industry standards, and company processes.
  • Perform other duties as assigned.

  • Must hold and maintain a Registered Nursing License.
  • Strong knowledge of group health/criteria sets/leadership/change management.
  • Must have strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
  • Must be proficient in Microsoft Office Suite, Outlook, internet navigation and general office equipment.
  • Must have the ability to follow instructions and respond to upper managements' directions accurately.
  • Ability to work independently, prioritize tasks, and manage time efficiently in a fast-paced environment.
  • Ability to demonstrate accuracy, thoroughness, and commitment to producing high quality work; actively monitor own performance and seek opportunities for improvement.
  • Ability to demonstrate flexibility and remain composed under pressure or in stressful conditions; adapts well to change and promotes a positive team environment.
  • Must be able to maintain confidentiality.
  • Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

What ExamWorks employees say

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About ExamWorks

Sourced by ZipRecruiter

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Atlanta, GA, US

Year founded

2008

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