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Remote Utilization Review Nurse Practitioner Jobs in Springfield, IL

AltaStaff, LLC

Care Review Clinician

Springfield, 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 ...

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Remote Utilization Review Nurse Practitioner information

See Springfield, IL salary details

$70.4K

$133.2K

$208.6K

How much do remote utilization review nurse practitioner jobs pay per year?

As of Aug 22, 2026, the average yearly pay for remote utilization review nurse practitioner in Springfield, IL is $133,174.00, according to ZipRecruiter salary data. Most workers in this role earn between $110,000.00 and $151,100.00 per year, depending on experience, location, and employer.

What is a remote utilization review nurse practitioner?

A Remote Utilization Review Nurse Practitioner is a licensed advanced practice nurse who evaluates the necessity, efficiency, and appropriateness of healthcare services, treatments, and hospital admissions, typically from a remote or home-based setting. They review patient medical records to ensure care meets established guidelines and insurance requirements, helping to control costs and ensure quality care. Their role often involves collaborating with physicians, insurance companies, and healthcare facilities to determine coverage and recommend alternative treatments when necessary. Working remotely, they rely heavily on electronic health records and telecommunication tools to perform their duties.

How does a remote utilization review nurse practitioner typically collaborate with healthcare teams while working offsite?

Remote Utilization Review Nurse Practitioners frequently collaborate with interdisciplinary teams through virtual meetings, secure messaging platforms, and electronic health record (EHR) systems. They work closely with physicians, case managers, and insurance representatives to review patient care plans, ensure medical necessity, and support appropriate resource utilization. Despite working remotely, maintaining clear communication and timely documentation is essential for seamless coordination and decision-making. Many organizations provide robust digital tools and regular team check-ins to facilitate collaboration and support remote staff.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse practitioner, and why are they important?

To thrive as a Remote Utilization Review Nurse Practitioner, you need an advanced nursing degree (NP), active state licensure, and strong knowledge of clinical guidelines and insurance criteria. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) are often required. Critical thinking, strong communication, and a detail-oriented approach set top performers apart in this remote role. These skills ensure accurate, compliant, and efficient review of patient care while supporting healthcare cost management and patient advocacy.

What is the difference between Remote Utilization Review Nurse Practitioner vs Telehealth Nurse Practitioner?

AspectRemote Utilization Review Nurse PractitionerTelehealth Nurse Practitioner
CertificationsNP license, possibly certification in utilization reviewNP license, general telehealth certifications
Work EnvironmentReviewing medical records, insurance data remotelyProviding patient care via telehealth platforms
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, telehealth companies

The main difference is that Remote Utilization Review Nurse Practitioners focus on reviewing medical necessity and insurance claims remotely, while Telehealth Nurse Practitioners provide direct patient care via telehealth platforms. Both roles require NP licensure, but their daily tasks and work environments differ significantly.

What are popular job titles related to Remote Utilization Review Nurse Practitioner jobs in Springfield, IL?

For Remote Utilization Review Nurse Practitioner jobs in Springfield, IL, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Nurse Practitioner jobs in Springfield, IL look for?

The top searched job categories for Remote Utilization Review Nurse Practitioner jobs in Springfield, IL are:

What cities near Springfield, IL are hiring for Remote Utilization Review Nurse Practitioner jobs?

Cities near Springfield, IL with the most Remote Utilization Review Nurse Practitioner job openings:

Remote Utilization Review Nurse Practitioner jobs near you

Care Review Clinician

AltaStaff, LLC

Springfield, IL • Remote

$40 - $42/hr

Full-time

Posted 3 days ago

New

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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