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Remote Utilization Review Rn Jobs in Illinois (NOW HIRING)

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Ourhrconnect

RN Medical Reviewer II

Tennessee, IL · On-site +1

Provides support and review of medical claims and utilization practices. Description Logistics ... This a full-time remote position. You will work an 8-hour shift scheduled during our normal ...

Ourhrconnect

RN Medical Reviewer II

Tennessee, IL · On-site +1

Provides support and review of medical claims and utilization practices. Description Logistics ... This a full-time remote position. You will work an 8-hour shift scheduled during our normal ...

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Remote Utilization Review Rn information

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

As of Aug 1, 2026, the average hourly pay for remote utilization review rn in Illinois is $40.97, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.07 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Illinois? For Remote Utilization Review Rn jobs in Illinois, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Illinois look for? The top searched job categories for Remote Utilization Review Rn jobs in Illinois are:
What cities in Illinois are hiring for Remote Utilization Review Rn jobs? Cities in Illinois with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Illinois as of July 2026, with employment types broken down into 72% Full Time, 11% Part Time, and 17% Contract. Highlights an 52% Physical, 3% Hybrid, and 45% Remote job distribution, with an average salary of $85,222 per year, or $41 per hour.

Utilization Review Registered Nurse

Hines and Associates, Inc

Rockford, IL • On-site, Remote

$57K - $62K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

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

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