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Remote Utilization Review Rn Jobs in Springfield, IL

AltaStaff, LLC

Care Review Clinician

Springfield, IL · Remote

$40 - $42/hr

This is a fully remote role but candidates must have a valid RN license in Illinois*** Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for ...

New

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 ...

micro1 AI

Pharmacovigilance Expert

Springfield, IL · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Clinical Pharmacy Technicians

Springfield, IL · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

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Remote Utilization Review Rn information

See Springfield, IL salary details

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$41

$68

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

As of Aug 21, 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 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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

Care Review Clinician

AltaStaff, LLC

Springfield, IL • Remote

$40 - $42/hr

Full-time

Posted 3 days ago

New

Job description

AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client!

Pay Rate: $40 - 42.00 hourly

Schedule: Monday-Friday 9am-5:30pm CST, Rotating Saturday 7-11am CST, Rotating Holidays

***This is a fully remote role but candidates must have a valid RN license in Illinois***

Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care.

  • Assess and analyze clinical service requests (e.g., surgeries, outpatient therapies, DME) using evidence-based MCP/MCG criteria.

  • Verify member benefits and eligibility and Process prior authorization determinations within regulatory timelines

  • Collaborate with multidisciplinary teams

  • Completes/reviews Authorizations, reviewing faxes that can be 50-100 pages long

  • Will be expected to manage 25-30 cases successfully daily.

  • Should be able to quickly and accurately determine whether the criteria meet medical necessity.

  • Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

  • Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and

  • guidelines.

  • Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

  • Additional duties assigned

Education/Experience: 

  • RN license in IL required

  • Must have 2+ years clinical practice experience (hospital, case management, utilization management)

  • Must have 1-3+ years of hospital or medical clinic, utilization review

  • Must have 2-3 years of Prior Authorization OR Med-Surg experience; Familiarity with Inpatient Medical Necessity

  • Must have solid experience within a clinical setting as RN’s must be able to use their knowledge to extrapolate key information during the authorization process

If you've applied and would like to view your application status, please visit: https://altastaff.zenople.com/login/ALTA

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

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