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Remote Utilization Review Rn Jobs in Jacksonville, IL

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Remote Utilization Review Rn information

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$21

$41

$68

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

As of May 29, 2026, the average hourly pay for remote utilization review rn in Jacksonville, IL is $41.79, according to ZipRecruiter salary data. Most workers in this role earn between $33.03 and $47.98 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 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 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 cities near Jacksonville, IL are hiring for Remote Utilization Review Rn jobs? Cities near Jacksonville, IL with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Director Clinical Documentation Integrity

QHC ARM Shared Services

Springfield, IL • Remote

$32.25 - $43.25/hr

Full-time

Posted 24 days ago

Job description

Director Clinical Documentation Integrity (CDI)

Remote Position
BSN and Registered Nurse (RN) License Required

The Clinical Documentation Integrity Specialist Director has a key role in the Mid-Revenue Cycle operations. The CDI Director leads CDI strategy, planning, development, implementation and maintenance of a best in class CDI program with demonstrated value to the organization. The CDI Director initiates, executes, and manages projects associated with Mid Revenue Cycle and CDI initiatives and goals. The CDI Director maintains and facilitates processes aligned with regulatory and legal requirements.

Job Summary:

  • Directs and manages the Clinical Documentation Integrity team with the development, implementation and maintenance of CDI processes, policies, education, productivity and daily operations.
  • Leads CDI strategy and planning at corporate level under the scope of executive leadership.
  • Manages, leads and is accountable for Mid Revenue Cycle/CDI projects.
  • Demonstrates extensive knowledge of APC, DRG and APR-DRG classification and reimbursement structures, ICD-10-CM and ICD-10-PCS.
  • Collaborates with Coding and HIM leadership to maximize team engagement, support and outcomes.
  • Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations.
  • Promotes physician and provider education, engagement and collaboration at the corporate and facility levels.
  • Represents CDI on multidisciplinary committees and work groups (e.g., Case Management, Utilization Review, HIM/Coding, Quality).
  • Leads and participates in leadership meetings to provide facilitation, subject matter expertise, and share best practices, revise policies and procedures, follow-up on action plans and identified opportunities, and modify workflows.
  • Regularly reports CDI performance, value and impact to facility and corporate leadership.
  • Demonstrates proficiency at data collection, analysis and reporting.
  • Displays ability to speak publicly and in key instances to executive leadership as well as at the point of contact at the facility level.
  • Promotes a culture of collaboration between hospital leadership and shared service professionals.
  • Leads by example and adherence to the ACDIS CDI Code of Ethics and AHIMA Standards of Ethical Coding, and the ACDIS/AHIMA CDI Practice Brief.
  • Develops, implements and monitors CDI processes to maximize efficiency and proficiency, demonstrating value to the organization.
  • Develops and monitors strategic operating goals, objectives and budget; and reports operational performance, justification and/or corrective action.
  • Oversees compliance with government and agency regulations.
  • Other duties as assigned.

Qualifications:

  • Graduate from a Nursing program and BSN required.
  • Master Degree in clinical, business, or leadership course of study preferred.
  • Current state Registered Nurse license.
  • Certification in CDI is strongly preferred.
  • Preferred: 5 years’ experience in a clinical course; 2-3 years’ experience in management.
  • The ideal candidate will have clinical documentation experience in an acute care facility, be certified in CDI, be Masters level prepared and have sound understanding of the scope and breadth of the position.
  • This is a remote position.