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Insurance Utilization Review Jobs in Springfield, IL

Ensure timely and accurate utilization review activities and payer communications. * Monitor ... Pet Insurance * More information is available on our Benefits Guest Website: benefits.uhsguest.com ...

Ensure timely and accurate utilization review activities and payer communications. * Monitor ... Pet Insurance * More information is available on our Benefits Guest Website: benefits.uhsguest.com ...

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Insurance Pre-Auth Spec I

Lincoln, IL · On-site

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Insurance Pre-Auth Spec I

Lincoln, IL · On-site

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

... utilization of evaluation, planning and implementation of a treatment plan in accordance with ... Kari@mhsil.com or schedule a call with me to discuss at To review Memorial's Benefits click here:

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Insurance Utilization Review information

See Springfield, IL salary details

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How much do insurance utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for insurance utilization review 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 an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

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

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are popular job titles related to Insurance Utilization Review jobs in Springfield, IL?

For Insurance Utilization Review jobs in Springfield, IL, the most frequently searched job titles are:

What cities near Springfield, IL are hiring for Insurance Utilization Review jobs?

Cities near Springfield, IL with the most Insurance Utilization Review job openings:

Infographic showing various Insurance Utilization Review job openings in Springfield, IL as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

DIR - UTILIZATION REVIEW / MGMT

UHS

Springfield, IL

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted yesterday


Universal Health Services rating

6.9

Company rating: 6.9 out of 10

Based on 254 frontline employees who took The Breakroom Quiz

456th of 891 rated healthcare providers


Job description

Responsibilities

We are hiring a Director of Case Management (Utilization Management) at Lincoln Prairie Behavioral Health Center and offering a $5,000 sign-on bonus!

Lincoln Prairie Behavioral Health Center is a 97-bed facility located in Springfield, Illinois. We are dedicated to providing youth with compassionate mental health treatment that encourages self-responsibility and personal growth. We are the only facility of our kind in Central Illinois! We provide psychiatric treatment to children and adolescents that present with a broad range of psychiatric and behavioral disorders. A clinically skilled multidisciplinary team works to partner with the youth and family to accomplish their goals in a supportive and therapeutic environment.

The Director of Case Management (Utilization Management) is responsible for the leadership, oversight, and daily operations of theUtilization Management and Case Management functions. This role ensures effective coordination of care, appropriate resource utilization, regulatory compliance, and collaboration with clinical andmultidisciplinary teams to support positive patient outcomes.


Qualifications

Duties and Responsibilities:

  • Provide operational and strategic leadership for the Case Management and Utilization Management
    departments.
  • Supervise, coach, and develop case managers and other assigned team members.
  • Ensure timely and accurate utilization review activities and payer communications.
  • Monitor patient progression, discharge planning, and continuity of care processes.
  • Collaborate with physicians, nursing leadership, therapists, and hospital administration.
  • Maintain compliance with regulatory, accreditation, and organizational requirements.
  • Analyze performance metrics and implement process improvement initiatives.

Benefit & Rewards Highlights

  • Retention Bonus Program
  • Loan Forgiveness Program
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Tuition savings
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • Pet Insurance
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

Requirements:

  • Registered Nurse (RN) preferred; Master's-level Clinical Social Worker will be considered.
  • 3-5 years of case management experience required.
  • 3-5 years of clinical team management or supervisory experience preferred.
  • Master’s degree in healthcare administration is a plus.
  • Strong knowledge of utilization management, discharge planning, and behavioral health operations.
  • Excellent leadership, communication, and interdisciplinary collaboration skills.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Qualifications:

Duties and Responsibilities:

  • Provide operational and strategic leadership for the Case Management and Utilization Management
    departments.
  • Supervise, coach, and develop case managers and other assigned team members.
  • Ensure timely and accurate utilization review activities and payer communications.
  • Monitor patient progression, discharge planning, and continuity of care processes.
  • Collaborate with physicians, nursing leadership, therapists, and hospital administration.
  • Maintain compliance with regulatory, accreditation, and organizational requirements.
  • Analyze performance metrics and implement process improvement initiatives.

Benefit & Rewards Highlights

  • Retention Bonus Program
  • Loan Forgiveness Program
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Tuition savings
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • Pet Insurance
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

Requirements:

  • Registered Nurse (RN) preferred; Master's-level Clinical Social Worker will be considered.
  • 3-5 years of case management experience required.
  • 3-5 years of clinical team management or supervisory experience preferred.
  • Master’s degree in healthcare administration is a plus.
  • Strong knowledge of utilization management, discharge planning, and behavioral health operations.
  • Excellent leadership, communication, and interdisciplinary collaboration skills.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Education:UNAVAILABLEEmployment Type: FULL_TIME

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US