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Remote Utilization Review Rn Jobs in Naperville, IL

Guidehealth

Remote RN Case Manager

Chicago, IL · On-site +1

As a registered nurse with an Illinois nursing license, you will work remotely to enhance the ... Knowledge of utilization review, quality improvement, managed care, and/or community health.

Rising Medical Solutions

Legal Nurse

Chicago, IL · Remote

Hold an active RN license in one or more states * Experience reviewing drafting and/or reviewing ... Minimum 5 years of clinical, legal, utilization review, or case management experience

Rising Medical Solutions

Legal Nurse

Chicago, IL · On-site +1

Hold an active RN license in one or more states * Experience reviewing drafting and/or reviewing ... Minimum 5 years of clinical, legal, utilization review, or case management experience

Rising Medical Solutions

Lead Legal Nurse

Chicago, IL · Remote

$34.75 - $47/hr

Hold an active RN license in one or more states * Experience reviewing drafting and/or reviewing ... Minimum 5 years of clinical, legal, utilization review, or case management experience

Rising Medical Solutions

Lead Legal Nurse

Chicago, IL · On-site +1

$35 - $47.50/hr

Hold an active RN license in one or more states * Experience reviewing drafting and/or reviewing ... Minimum 5 years of clinical, legal, utilization review, or case management experience

Phamily

Clinical Care RN

Villa Park, IL · Remote

$75K - $95K/yr

This position is remote and offers health benefits as well as a retirement plan and paid days off ... review meetings * Serve as a liaison for payer utilization management, interpreting policy, and ...

Phamily

Clinical Care RN

Oakbrook Terrace, IL · Remote

$75K - $95K/yr

This position is remote and offers health benefits as well as a retirement plan and paid days off ... review meetings * Serve as a liaison for payer utilization management, interpreting policy, and ...

Med-Metrix

Physician Advisor - Fully Remote

Chicago, IL · On-site +1

Provides consultation to attendings, nurses, and case management staff regarding complex clinical ... Board Certification by the American Board of Quality Assurance and Utilization Review Physicians ...

Corvel

Telephonic Case Manager II

Downers Grove, IL · Remote

$66K - $101K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

Corvel

Telephonic Case Manager II

Downers Grove, IL · Remote

$65K - $98K/yr

Current RN Licensure in state of operation * 3 or more years of recent clinical experience ... Strong cost containment background, such as utilization review or managed care helpful

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

As of Jun 18, 2026, the average hourly pay for remote utilization review rn in Naperville, IL is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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.
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Remote Utilization Review Rn jobs near you

Lead Utilization Management Nurse

First Match Services, Inc.

Oak Brook, IL • On-site, Remote

Full-time

Retirement, PTO

Posted 16 days ago

Job description

We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings and shared-risk models. They deliver timely, turn-key solutions for healthcare providers, health plans and strategic partners.
In this position as the Lead Utilization Management Nurse you will provide expertise in Utilization Management while managing a small team of UM nurses to help ensure that every patient receives the right type of care, at the right time in the right setting, every day! You will also provide hands-on expertise to help implement company strategies and provide oversight of assigned IPA Utilization Management program.
Some other responsibilities include:
  • Conducting monthly client UM Committee meetings
  • Act as a resource for the UM Nurses (first point of contact for clinical clarification/education)
  • Participate in data analysis of utilization metrics
  • Prepare, participate and present summary utilization management reports to UM/QM Committee
  • Much More!

QUALIFICATIONS
  • Bachelor of Science degree (AND or BSD) in Nursing
  • At least 4-5 years of relevant professional experience, including medical management experience in health plans, provider, or MSO settings and quality chart reviews
  • Registered Nurse (RN) with a current and active nursing license to practice in the State of Illinois is required 
  • A minimum of three (3) years of responsible leadership experiences in management positions
  • Certified Case Manager (CCM) preferred
  • Knowledge/experience in Medicare/Medicaid and HEDIS criteria is highly desirable
  • Valid Driver's License and vehicle required
  • Ability to travel at least 30% for client meetings within the state required

ADDITIONAL DETAILS
  • On-site gym FREE to employees
  • On-site deli
  • Professional Development Opportunities
  • Great base salary with bonus potential
  • Full benefits, 401k and PTO allowance
  • Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor.