ZipRecruiter

Log In

2

Remote Utilization Review Jobs in Wheaton, IL (NOW HIRING)

Bcbsa

Director, Trade Client Relations

Chicago, IL · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Redwood Logistics

Legal Assistant

Chicago, IL · On-site +1

$50K - $60K/yr

Remote Status: Exempt; Salaried Who We Are: Recognized by Gartner in their Modern 4PL Market Guide ... Identify potential risks associated with contracts under review; * Assist with utilization of the ...

Redwood Logistics

Legal Assistant

Chicago, IL · On-site +1

$50K - $60K/yr

Remote Status: Exempt; Salaried Who We Are: Recognized by Gartner in their Modern 4PL Market Guide ... Identify potential risks associated with contracts under review; * Assist with utilization of the ...

Brainlab

National Technical Support

Chicago, IL · On-site +1

$38K - $48K/yr

... and utilization of engineering expertise; manages team schedule to ensure efficient resource ... out Remote Performance Reviews; responsible for escalated case support which includes ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Wheaton, IL

Remote Utilization Review information

See Wheaton, IL salary details

$20

$40

$66

How much do remote utilization review jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for remote utilization review in Wheaton, IL is $40.87, according to ZipRecruiter salary data. Most workers in this role earn between $32.31 and $46.92 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in remote utilization review?

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.

What does a remote utilization review do?

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.

What is a remote utilization review?

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.

What are popular job titles related to Remote Utilization Review jobs in Wheaton, IL? For Remote Utilization Review jobs in Wheaton, IL, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Wheaton, IL look for? The top searched job categories for Remote Utilization Review jobs in Wheaton, IL are:
What cities near Wheaton, IL are hiring for Remote Utilization Review jobs? Cities near Wheaton, IL with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Wheaton, IL as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 25% In-person, and 75% Remote job distribution, with an average salary of $85,001 per year, or $40.9 per hour.

Quality Review Specialist (RN or LPN/LVN)

VIVA USA INC

Downers Grove, IL • On-site, Remote

Contractor

Posted 16 days ago

Job description

Work closely with Utilization Management (UM), Case Management (CM) and Customer Service (CS) to ensure appeal process meets established guidelines.
Adhere to accreditation and regulatory requirements to improve customer service and achieve organizational goals related to complaint and appeal resolution.
Manage individual inventory through appropriate workflow.
Facilitate final resolution of member and provider appeals.
Participate in department initiatives related to NCQA and URAC audits, DOI audits, revision project, audits, and correspondence revision projects.
Serve on workgroups.
Adhere to compliance with external regulatory and accreditation standards.
Facilitate access to appeal files by members or member designee under federal guidelines.
Provide data for required reporting. 10.Work directly with members and providers to resolve appeals.
Support other team members in appeal resolution and in fulfilling other department responsibilities.
Assist in maintaining working relationships across organizational lines.
Ensure our member/providers requirements are met at all times.
Communicate and interact effectively and professionally with co-workers, management, customers, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintain complete confidentiality of company business.
Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
Applicants must hold an active RN or LPN/LVN license in good standing.
Bachelor's Degree OR 4 years in health care experience.
5 years utilization management, appeals, claims and mainframe system experience.
Experience in health operations.
Experience with internal/external customer relations.
Knowledge of managed care processes.
Knowledge and familiarity of national accreditation standards, specifically NCQA and URAC standards.
Knowledge of state and federal health care and health operations regulations.
Organizational skills and ability to meet deadlines and manage multiple priorities.
Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.
PC proficiency to include Microsoft Word, Access, and Excel.
PREFERRED JOB REQUIREMENTS:
Appeals or Utilization management experience.
Notes:
Fully remote
This is a M-F shift 40 hours per week, with MANDATORY holiday and weekend rotations.
Holidays rotation scheduled 3-4 holidays per year and one weekend every 3rd weekend.
This is a contract role with the possibility of conversion to full-time based on business needs and performance
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Apply