Springfield, IL · On-site +1
$10K - $12K/mo
... utilization review of provider submitted invoices for proper payment adjudication. The ideal ... Flexible work schedules are available in many program areas. (Remote work may be an option for ...
Springfield, IL · On-site +1
$10K - $12K/mo
... utilization review of provider submitted invoices for proper payment adjudication. The ideal ... Flexible work schedules are available in many program areas. (Remote work may be an option for ...
Springfield, IL · On-site +1
$10K - $12K/mo
... utilization review of provider submitted invoices for proper payment adjudication. The ideal ... Flexible work schedules are available in many program areas. (Remote work may be an option for ...
Springfield, IL · On-site +1
$10K - $12K/mo
... utilization review of provider submitted invoices for proper payment adjudication. The ideal ... Flexible work schedules are available in many program areas. (Remote work may be an option for ...
Medicaid Business / QA Analyst * 7-12+ Month Contract | Remote | No ThirdParty Firms | Medicaid SME ... Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy ...
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Medicaid Business / QA Analyst * 7-12+ Month Contract | Remote | No ThirdParty Firms | Medicaid SME ... Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy ...
Springfield, IL · Remote
$40 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...
Quick apply
Springfield, IL · Remote
$40 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...
Springfield, IL · Remote
$40 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...
Quick apply
Springfield, IL · Remote
$40 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting ...
Quick apply
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting ...
$21.20 - $25.49
2% of jobs
$25.49 - $29.78
9% of jobs
$32.71 is the 25th percentile. Wages below this are outliers.
$29.78 - $34.07
21% of jobs
The median wage is $37.54 / hr.
$34.07 - $38.36
23% of jobs
$38.36 - $42.65
13% of jobs
$45.98 is the 75th percentile. Wages above this are outliers.
$42.65 - $46.93
10% of jobs
$46.93 - $51.22
8% of jobs
$51.22 - $55.51
5% of jobs
$55.51 - $59.80
5% of jobs
$59.80 - $64.09
2% of jobs
$64.09 - $68.38
2% of jobs
$21
$41
$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.
$10K - $12K/mo
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 5 days ago
7.8
Based on 72 frontline employees who took The Breakroom Quiz
20th of 50 rated states
Job Requisition ID: 56251
BPIS: 10179
Opening Date: 06/02/2026
Closing Date: 06/16/2026
Agency:Department of Healthcare and Family Services
Class Title: SENIOR PUBLIC SERVICE ADMIN (40070)
Skill Option: General Administration/Business Marketing/Labor/Personnel
Bilingual Option: None
Salary: Anticipated starting salary: $10,500 - $12,500/mo
Job Type: Salaried
Category: Full Time
County: Sangamon
Number of Vacancies: 1
Bargaining Unit Code: None
Merit Comp Code: Federally Funded, Gubernatorial (Management Bill) Exclusion from Collective Bargaining Coverage
A resume is highly encouraged to evaluate your qualifications and skills as part of your application. Please attach a DETAILED Resume/Curriculum Vitae (CV) to the MY DOCUMENTS section of your application if you decide to provide one.
Why Work for Illinois?
Working with the State of Illinois is a testament to the values of compassion, equity, and dedication that define our state. Whether you’re helping to improve schools, protect our natural resources, or support families in need, you’re part of something bigger—something that touches the lives of every person who calls Illinois home.
No matter what state career you’re looking for, we offer jobs that fit your life and your schedule—flexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.
Position Overview:
The Department of Healthcare and Family Services, dedicated to improving lives for Illinoisans, is seeking to hire a highly motivated, qualified individual as a Senior Public Service Administrator who will serve as the Bureau of Claims Processing, Error Resolution Section Manager. The ideal candidate will demonstrate an overall strong skill set that will ensure the Bureau of Claims Processing maintains the highest level of standards in all operations within the Bureau, particularly in processing medical claim documents for timely payments to the provider community, online correction and utilization review of provider submitted invoices for proper payment adjudication. The ideal candidate will demonstrate their dedication to teamwork, the ability to work in a fast-paced, ever-changing environment, a strong supervisory background, including experience managing a large staff, knowledge of the Department’s goals and objectives, knowledge and experience managing large scale processing operations, and the desire to promote and provide quality services on behalf of the State of Illinois. We invite qualified candidates to consider joining the Bureau of Claims Processing team to continue the overall mission of the Department of Healthcare and Family Services.
HFS values employees with different backgrounds, life experiences, and talents.
Employees receive a robust benefit package including:
If you are seeking a new opportunity, and this position appeals to you, please apply today!
At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained.
HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.
Work Hours: Monday - Friday 8:30 am - 5:00 pm
Headquarter Location: 201 S Grand Ave E, Springfield, Illinois, 62704
Work County: Sangamon
Agency Contact: HFS.DMPApps@illinois.gov
Posting Group: Leadership & Management
Statement of Economic Interest:
This position has been found to meet the requirements in section 4A-101 of the Illinois Governmental Ethics Act requiring the occupant/employee to file a Statement of Economic Interest. The Illinois Governmental Ethics Act (5 ILCS 420/4A et seq.) requires certain state officials and employees to file annual Statements of Economic Interest with the Office of the Secretary of State that will be made available for examination and copying by the public. All employees required to file a Statement of Economic Interest are also required to file the Supplemental Statement of Economic Interest with the Executive Ethics Commission. (See Executive Order 15-09) Fines and penalties apply to untimely filings.
The main form of communication will be through email. Please check your “junk mail”, “spam”, or “other” folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:
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The State of Illinois is not a traditional company, but rather a governmental entity encompassing diverse agencies and departments that serve the constituents of Illinois. Based in Illinois, United States, this governmental body communicates with its citizens through the official website illinois.gov. The website is a one-stop resource for Illinois residents to access information about the state's services, including education, healthcare, transportation, and public safety, among others.
11 - 50 Employees
Springfield, IL, US
2009
