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Remote Utilization Review Rn Jobs in Springfield, IL

Humana

Manager, Care Management

Springfield, IL · Remote

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Springfield, IL · Remote

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

Humana

Manager, Care Management

Springfield, IL · Remote

Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Springfield, IL

Remote Utilization Review Rn information

See Springfield, IL salary details

$21

$41

$68

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 Springfield, IL is $41.91, 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 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 Springfield, IL? For Remote Utilization Review Rn jobs in Springfield, IL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Springfield, IL look for? The top searched job categories for Remote Utilization Review Rn jobs in Springfield, IL are:
What cities near Springfield, IL are hiring for Remote Utilization Review Rn jobs? Cities near Springfield, IL 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 Springfield, IL as of July 2026, with employment types broken down into 69% Full Time, 15% Part Time, and 16% Contract. Highlights an 42% Physical, 4% Hybrid, and 54% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

CQI Specialist - LPN/RN (Northern Illinois) (78484)

Centurion Health

Springfield, IL • Remote

$100K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Centurion Health rating

6.4

Company rating: 6.4 out of 10

Based on 139 frontline employees who took The Breakroom Quiz

640th of 887 rated healthcare providers

Job description

Salary up to $100k (depending on experience)

Centurion is proud to be the provider of comprehensive services to the Illinois Department of Corrections.   We are currently seeking a Full-time CQI Specialist to join our Regional Office team. This is a remote/traveling position. Candidates must reside in Northern Illinois and live a commutable distance to our sites for visits as needed (approximately 2-4 days/week). Occasional travel to Springfield, IL for regional meetings is also required. 

Based out of the regional office, the Statewide CQI Specialist develops and implements the Continuous Quality Improvement (CQI) program in accordance with the mission and strategic goals of the company, federal and state laws and regulations, accreditation standards and specific contractual requirements.

  • Licensure as a RN or Bachelor’s Degree (Master’s Degree preferred) in a clinical or allied health field from an accredited institution required
  • Certification as a Professional in Healthcare Quality (CPHQ) preferred
  • Minimum of two years of experience in health information, quality, utilization or risk management
  • Minimum of two years of experience in Quality Assurance/ Continuous Quality Improvement preferred
  • Knowledge of statistics, data collection, analysis and data presentation
  • Skilled in use of computer software for maintaining statistics and developing reports
  • Excellent problem solving and writing skills
  • Experience in a correctional setting preferred
  • Must be appropriately and actively certified in Cardio-Pulmonary Resuscitation (CPR)
  • Ability to obtain a security clearance, to include drug screen and criminal background check

We offer excellent compensation and comprehensive benefits for our full-time team members including:

  • Health, dental, vision, disability and life insurance
  • 401(k) with company match
  • Generous paid time off
  • Paid holidays
  • Flexible Spending Account
  • Continuing Education benefits
  • Much more...

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