ZipRecruiter

Log In

2

Remote Utilization Review Manager Jobs in Rochelle, 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

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 ...

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 ...

Donaldson Company, Inc.

EHS Manager

Dixon, IL · On-site +1

$103K - $134K/yr

Leads the post-incident review of high-consequence EHS incidents and ensures that corrective and ... Coordinates utilization of Donaldson's change management process to evaluate potential health and ...

Harris

(Remote) GIS Developer

Oregon, IL · Remote

Our Outage Management team is dedicated to building resilient, scalable, and mission-critical ... Participate in code reviews to ensure adherence to company standards and industry best practices.

Harris

(Remote) GIS Developer

Oregon, IL · Remote

Our Outage Management team is dedicated to building resilient, scalable, and mission-critical ... Participate in code reviews to ensure adherence to company standards and industry best practices.

next page

Showing results 1-20

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

Remote Utilization Review Manager information

See Rochelle, IL salary details

$37.9K

$88.5K

$162.9K

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

As of Jul 27, 2026, the average yearly pay for remote utilization review manager in Rochelle, IL is $88,500.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,900.00 and $106,500.00 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, and why are they important?

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 Rochelle, IL? For Remote Utilization Review Manager jobs in Rochelle, IL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Rochelle, IL look for? The top searched job categories for Remote Utilization Review Manager jobs in Rochelle, IL are:
What cities near Rochelle, IL are hiring for Remote Utilization Review Manager jobs? Cities near Rochelle, IL with the most Remote Utilization Review Manager job openings:
Remote Utilization Review Manager jobs near you

Utilization Review Registered Nurse

Hines and Associates, Inc

Rockford, IL • On-site, Remote

$57K - $62K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 18 days ago

Job description

Nurses - are you looking for a change? Want to work no nights, no weekends, and no holidays? Check out Hines & Associates!
Experience in both medical and behavioral health and/or substance use disorder settings is required.
ABOUT US:
Hines is a nationwide, independent leader in personalized managed health care, focused on what's important to you-comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.'s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.
WHAT WE OFFER:
  • Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available!
  • 401k plan with company match, fully vested after 1 year.
  • No weekends and nights!
  • Paid Holidays
  • Work-life balance.
  • Remote setting

ROLE DESCRIPTION:
This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines' programs.
*****This is a Monday through Friday position, 9:30 AM to 6:00 PM.******
RESPONSIBILITIES AND PERFORMANCE:
  • Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial clinical reviews. .
  • Demonstrates ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention. Provides certification of medical, disability and workers compensation cases.
  • Demonstrates a thorough understanding of criteria sets and their limitations including when a second level review is required.
  • Evaluates appropriateness of current plan of care.
  • Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner.
  • Maintains knowledge of current advances and trends in medical care.
  • Demonstrates knowledge of URAC guidelines, Hines policies and procedures, and standards of practice and their revisions. Able to attain and maintain the minimal quality assurance performance standards.
  • Demonstrates assertiveness in completion of precertification and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements and according to the Hines policies and procedures.
  • Performs onsite evaluations as needed or requested.
  • Additional responsibilities as assigned.

PM21
COMMUNICATION:
  • Communicates with hospital staff, physicians, other providers and Hines customer contacts in a competent, calm, effective and professional manner.
  • Effectively communicates the need to refer to a higher-level review for questionable plans of treatment.
  • Provides written documentation concerning the clinical information obtained regarding the patient's status, benefit and claim concerns, and validation of criteria.
  • Communicates knowledge of policies and procedures, URAC guidelines, disability and workers compensation regulations, state and federal requirements, and standards of practice.

PERSONAL AND PROFESSIONAL:
  • Participates in self-evaluation by identifying areas of strength and limitations and offers and accepts constructive criticism.
  • Creative and assertive.
  • All First Level Reviewers are required to sign and honor a confidentiality statement at the time of hire and annually at the time of performance reviews.

Requirements
QUALIFICATIONS:
  1. Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC.
  2. Must have Mental Health or Substance Abuse experience.
  3. Successful completion of UR nurse orientation program.
  4. Minimum of 3 years recent acute clinical practice required, 5 years preferred.
  5. Managed care, disability or workers compensation experience helpful but not mandatory.
  6. Customer service oriented.

*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.*
Salary Description
$57,244 - $62,180 per year

Apply