This is a fully remote or office/home hybrid position. Your Responsibilities: * Review patient admission and clinical information to ensure medical necessity and compliance of utilization review ...
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This is a fully remote or office/home hybrid position. Your Responsibilities: * Review patient admission and clinical information to ensure medical necessity and compliance of utilization review ...
Quick apply
This is a fully remote or office/home hybrid position. Your Responsibilities: * Review patient admission and clinical information to ensure medical necessity and compliance of utilization review ...
Skokie, IL ยท On-site +1
This is a fully remote or office/home hybrid position. Your Responsibilities: * Review patient admission and clinical information to ensure medical necessity and compliance of utilization review ...
Skokie, IL ยท On-site +1
This is a fully remote or office/home hybrid position. Your Responsibilities: * Review patient admission and clinical information to ensure medical necessity and compliance of utilization review ...
Chicago, IL ยท On-site +1
$70K - $75K/yr
The Utilization Management Registered Nurseis responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
Chicago, IL ยท On-site +1
$70K - $75K/yr
The Utilization Management Registered Nurseis responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
The Utilization Management Registered Nurse is responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
Quick apply
The Utilization Management Registered Nurse is responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
Chicago, IL ยท Remote
$70K - $75K/yr
The Utilization Management Registered Nurse is responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
Chicago, IL ยท Remote
$70K - $75K/yr
The Utilization Management Registered Nurse is responsible for performing utilization review ... Communicating review determinations (written and/or verbal) to providers, members, and other ...
Downers Grove, IL ยท On-site +1
Downers Grove, Illinois Case Management Direct RN Remote Case Manager - Metro Chicago Area (with ... Utilization Management, Utilization Review, Managed Care, or Cost Containment experience * CCM ...
Downers Grove, IL ยท On-site +1
Downers Grove, Illinois Case Management Direct RN Remote Case Manager - Metro Chicago Area (with ... Utilization Management, Utilization Review, Managed Care, or Cost Containment experience * CCM ...
Chicago, IL ยท On-site +1
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred * Physician Advisor Sub-Specialty Certification by the American Board of ...
Chicago, IL ยท On-site +1
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred * Physician Advisor Sub-Specialty Certification by the American Board of ...
Lombard, IL ยท Remote
$70.97 - $125/hr
... utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical ...
Lombard, IL ยท Remote
$70.97 - $125/hr
... utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical ...
Lombard, IL ยท On-site +1
$70.97 - $125/hr
... utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical ...
Lombard, IL ยท On-site +1
$70.97 - $125/hr
... utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical ...
Oak Brook, IL ยท On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team ... reviews * Registered Nurse (RN) with a current and active nursing license to practice in the State ...
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Oak Brook, IL ยท On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team ... reviews * Registered Nurse (RN) with a current and active nursing license to practice in the State ...
Chicago, IL ยท Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
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Chicago, IL ยท Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
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Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
Quick apply
Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
Quick apply
Northbrook, IL ยท Remote
$28.25/hr
... for utilization review. MD (or equivalent) level training is required but current Board ... This position is remote (work from home) and is part-time, with a focus on weekend hours. Please ...
Chicago, IL ยท Remote
... utilization review criteria while located in a state or territory of the United States.Reviews ... Flexible scheduling and work/life balance with remote and work from home opportunities4 weeks of ...
Chicago, IL ยท Remote
... utilization review criteria while located in a state or territory of the United States.Reviews ... Flexible scheduling and work/life balance with remote and work from home opportunities4 weeks of ...
... utilization reviews, and crisis interventions as needed - Meet billing and service hour targets while ensuring compliance with Medicaid/DCFS standards Benefits: - Remote flexibility to work from home ...
... utilization reviews, and crisis interventions as needed - Meet billing and service hour targets while ensuring compliance with Medicaid/DCFS standards Benefits: - Remote flexibility to work from home ...
Des Plaines, IL ยท Remote
$55K - $90K/yr
This remote position includes occasional travel and is ideal for candidates based in states in the ... Experience with nurse case management, IME, utilization review, or medical bill review services ...
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Des Plaines, IL ยท Remote
$55K - $90K/yr
This remote position includes occasional travel and is ideal for candidates based in states in the ... Experience with nurse case management, IME, utilization review, or medical bill review services ...
Chicago, IL ยท On-site +1
Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and ...
Chicago, IL ยท On-site +1
Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and ...
Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and ...
Quick apply
Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and ...
Chicago, IL ยท Remote
$65K - $80K/yr
... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ... Always accepting applications. #claimsexaminer#claims #hybrid#LI-REMOTE Sedgwickis an Equal ...
Chicago, IL ยท Remote
$65K - $80K/yr
... utilization review. * Maintains professional client relationships. QUALIFICATIONS Education and ... Always accepting applications. #claimsexaminer#claims #hybrid#LI-REMOTE Sedgwickis an Equal ...
$21.25 - $25.55
2% of jobs
$25.55 - $29.85
9% of jobs
$32.79 is the 25th percentile. Wages below this are outliers.
$29.85 - $34.15
21% of jobs
The median wage is $37.63 / hr.
$34.15 - $38.45
23% of jobs
$38.45 - $42.75
13% of jobs
$46.09 is the 75th percentile. Wages above this are outliers.
$42.75 - $47.05
10% of jobs
$47.05 - $51.35
8% of jobs
$51.35 - $55.64
5% of jobs
$55.64 - $59.94
5% of jobs
$59.94 - $64.24
2% of jobs
$64.24 - $68.54
2% of jobs
$21
$42
$68
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 3 days ago
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Finance and insurance
51 - 200 Employees
Niles, IL, US
2016