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Remote Utilization Review Nurse Jobs in Romeoville, IL

Capstone Search Group

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Small Group Employee Benefits Consultant - Remote (10269)

Chicago, IL · Remote

$85K - $100K/yr

About the Role 100% remote opportunity for an insurance professional knowledgeable with group ... Review current programs, evaluate claims and utilization data * Take proposals to market to help ...

New

YO AI Labs

Pharmacovigilance Expert - Remote

Chicago, IL · Remote

$70 - $80/hr

Author and review evaluation tasks based on DSURs, PSURs/PBRERs, safety data, and case-level ... Advanced degree in life sciences, pharmacy, nursing, medicine, or related fields (PharmD, MD, MSc ...

IQVIA

Flex Nurse Educator

Chicago, IL · Remote

Deliver remote patient education, including medication administration training and adherence ... Candidates must possess a valid driver's license and will be subject to a review of their driving ...

IQVIA

Flex Nurse Educator - Chicago S, IL

Chicago, IL · Remote

Deliver remote patient education, including medication administration training and adherence ... Candidates must possess a valid driver's license and will be subject to a review of their driving ...

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Remote Utilization Review Nurse information

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

As of Aug 20, 2026, the average hourly pay for remote utilization review nurse in Romeoville, IL is $43.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.09 and $49.52 per hour, depending on experience, location, and employer.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

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

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Romeoville, IL as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, 5% Contract, and 2% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $89,671 per year, or $43.1 per hour.

Tele-Triage Registered Nurse - RN

Starting Point Nursing Services

Chicago, IL • On-site, Remote

$33 - $35/hr

Full-time

Posted 15 days ago

Job description

Our Company

Starting Point Nursing Services

Overview

Full Time Tele-Triage (Fully Remote) Registered Nurse Position:

*Must have compact state RN licensure from the state in which you currently reside

*Remote Triage & Home Health RN experience highly preferred

*Potential Start Date:  9/14/26

New Available FULL TIME Schedule:

* Tuesday, Wednesday, Thursday 2p-10p CST (3p-11p EST) & Friday 11a-7p CST (12p-8p EST) & Saturday 8a-4p CST (9a-5p EST)

This Registered Nurse provides On-Call and Triage for the assigned population in accordance with triage protocols. This position remotely develops/implements care plans for persons served in the area of responsibility. The Tele-Triage RN assesses health status, identifies problems and needs of person(s) served in their assigned caseload, develops nursing care plans in collaboration with operations RN's. You will complete chart reviews and monthly host home reviews and perform On-Bound calling to assigned populations/locations. This RN performs data analysis in multiple systems.

Responsibilities
  • Monitor assigned phone lines during service hours to ensure timely response for caller needs
  • Triage all symptom-based calls and give recommendations according to the approved triage protocol
  • Triage patients by assessing severity of symptoms and referral to appropriate setting or level of care
  • Document in real time all care related recommendations and ensure local operations are notified of triage supports and outcomes
  • Initiate contact with acute care setting to coordinate services for clients receiving care in the ED/Hospital and coordinate the discharge planning; Notify operations of triage recommendations
  • Coordinate any medication orders with the assigned pharmacy and update MAR/QuickMar for appropriate administration
  • Work assigned prior authorizations to ensure timely documentation and submit to assigned pharmacy for billing
  • Complete/conduct assessment and reassessment of persons served as assigned
  • Develop/update care plans and determine persons served needs and secure physicians orders as needed
  • Communicate with beneficiaries primarily phone, text, online (web) chat, or email
  • Ensure compliance with state/local/payer requirements through review of documentation
  • Provide coaching and education related to the health and well-being of persons served
  • Participate in performance improvement activities and maintain ongoing clinical knowledge through internal/external training programs
  • Document above actions in Nurse's Notes or Service Delivery Log
  • Maintain time sheet log for weekly submission for productivity management to assigned supervisor
  • Notify each practice, physician, and/or managed care client of all encounters with patients, parents, or managed care clients regardless of follow-up needs before office opening
  • Notify designated leadership of operational concerns
  • Actively participate in applicable meetings and committees as requested (e.g., IDT, HRC, Safety/Quality committee, and annual person served directed/active treatment plan meetings)
Qualifications
  • Degree/certification from an accredited school of nursing
  • Current licensure as a Registered Nurse (RN) in the state of practice, which is current and remains in good standing. Must have a compact state RN license.
  • Clinical experience in providing services and supports to individuals with intellectual and developmental disabilities, home health and Hospice patients or related disorders
  • Two year Home Health nursing experience
About our Line of BusinessStarting Point Nursing Services, an affiliate of BrightSpring Health Services, is staffed 100% by a team of remote registered nurses trained to support the post-acute continuum with clinical advice and interventions. Our 24/7 On-Call and Triage team responds to physician practices, home health agencies, intellectual disability providers, and assisted living providers. Our services are tailored to our partners, including remote physical/chart assessments, predictive care modeling, clinical programming interventions for high-risk populations, emergent care coordination, and case management. For more information, please visit www.startingpointnursing.com. Follow us on LinkedIn.Salary RangeUSD $33.00 - $35.00 / HourEmployment Type: FULL_TIME

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