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Insurance Utilization Review Jobs in Springfield, IL

Memorial Health

Patient Access Specialist I

Springfield, IL · On-site

$16 - $23.64/hr

To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Education: High ... Identifies/captures appropriate health insurance benefit eligibility based on contract/regulatory ...

Memorial Health

Patient Access Specialist I

Springfield, IL · On-site

$16 - $23.64/hr

To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Education: High ... Identifies/captures appropriate health insurance benefit eligibility based on contract/regulatory ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 11, 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 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.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

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 is an Insurance Utilization Review job?

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 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 job categories do people searching Insurance Utilization Review jobs in Springfield, IL look for? The top searched job categories for Insurance Utilization Review jobs in Springfield, IL 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:
Insurance Utilization Review jobs near you
Program Supervisor

Program Supervisor

Lutheran Child and Family Services of Illinois

Springfield, IL

$69K - $74K/yr

Full-time

Posted 18 days ago

Job description

Effective Date: March 1, 2024
MANAGEMENT JOB DESCRIPTION
Job Title: Program Supervisor
Exempt/Non-exempt: EXEMPT
Immediate Supervisor: Program Manager
Salary Range: $69,476 - $74,476
Benefits: Click Here to view LCFS’ Full-Time Employee Benefits.
Essential Functions:
  1. Primarily responsible for leading a team of direct service child welfare professionals in partnering with children, parents, and community providers to assess, plan, evaluate, and make linkages for in-home stabilization, prevention, safety, permanency, and well-being outcomes.
  2. Train program staff in their role, ensuring the development of a skilled and dedicated team.
  3. Facilitates regular team meetings to discuss case progress, share information, address challenges, and promote teamwork and collaboration among staff members.
  4. Implementation and referral of individualized and targeted services for youth and families, such as counseling, respite, mentoring, educational support, case management, crisis intervention, and continual language to services to meet the specialize needs of children/families.
  5. May work evenings, weekends, and occasional holidays. Willingness to travel through high-risk communities as
  6. needed.
  7. Complies with all requirements regarding utilization of the DCFS electronic record-keeping system (SACWIS). Prepares written service plans for each client as required by DCFS contract. Maintains up-to-date and accurate client files and databases, as required by agency/programmatic policies and procedures, professional standards, and external requirements of all relevant, regulatory, licensing, or accrediting body’s. Implements, continuous quality improvement in all aspects of performance.
  8. Provides regular and effective supervision, mediation, problem resolution, oversight and crisis response to staff by effectively responding to workforce, parent, child, provider and other stakeholder concerns and demonstrating the ability to effectively manage crisis and difficult case situations.
  9. Reviews intake information of clients referred for services and determines if the referral will be accepted.
  10. Reviews all written documents generated by staff.
  11. Attends court hearings, case reviews, staffing, and meetings as needed.
  12. Reviews funding source policies and procedures and trains staff on the implementation of these procedures.
  13. Ensures that staff handle unusual incidents in a prompt and effective manner.
  14. Participates in various collateral and community groups to promote agency programs and to network with the community, creating community linkages and opportunities.
  15. Provides a welcoming and receptive environment in all contacts with clients, agency, staff and collateral contacts. Develops understanding and continuously develops self-awareness related to diversity, inclusion, and equity issues.
  16. Perform other duties as assigned.
Knowledge and Ability Requirements:
  • Ability to drive one’s own vehicle and transport children, youth, and adults as needed.
  • In-depth knowledge of child welfare systems, regulations, and best practices.
  • Strong case management skills, including assessments, service planning, and progress monitoring.
  • Ability to advocate for children's rights and best interests within the child welfare system.
  • Excellent communication skills, both verbal and written, for effective interaction with families, children, professionals, and agencies.
  • Ability to provide crisis intervention and support to children and families facing challenging circumstances.
Education and Experience:
A Master’s degree in Social Work or a related Human Service field with a minimum of 2 years of experience in Child Welfare is required. Candidate must have CWEL certification. Management experience involving multiple staff, characterized by staff development and stability, is also required. The ability to plan, organize, and communicate effectively in a management capacity is essential.
Physical Demands and Other Requirements:
To perform this job successfully, an individual must be able to perform the essential duties listed in the job description satisfactorily. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; use hands to finger, handle or feel objects, or controls; reach with hands and arms. Capable of operating standard office equipment, including a computer and keyboard, and typical business machines such as a fax machine and copier. The employee must occasionally lift and/or move up to 20-30 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. The employee is required to have valid driver’s license, auto insurance and must be able to safely operate a motor vehicle. The work environment characteristics include a noise level which is usually low to moderate.
Position Responsibilities/Program Execution and Decision Making:
  • Supervision and Management: Communicates regularly through individual, supervisory and group meetings to implement Agency and programmatic goals and requirements. Provides accurate and timely feedback to each employee under his/her supervision and demonstrates ability to analyze employee performance. Facilitates a positive work environment where staff feel free to communicate openly. Responds to incidents and complaints in a timely manner and appropriately informs and consults with their chain of command.
  • Leadership: Demonstrates foresight in recognizing problems and vision in identifying and implementing solutions. Ensures program is effective in producing desired outcomes and program goals and deliver services at required capacity. Demonstrates ability to quickly gather pertinent facts, weigh options and make decisions in critical situations while informing and consulting with others as needed. Works with staff to support and implement management decisions.
  • Diversity and Inclusion/ Professionalism: In all aspects of their work presents as a role model to others, behaving in a way which actively supports LCFS as a welcoming community, promotes diversity and inclusion in the workplace and collaborates with others to further equity and dismantle barriers to a more inclusive experience of community. Participates in annual professional development and/or advocacy regarding inclusion.
  • Ethical Conduct: Follows all ethics policies and procedures related to program execution and decision making as defined by the agency as well as any related professional licensing, regulatory or accrediting body. Maintain confidentiality of client, staff, and agency information. Reports any known or suspected breaches of confidentiality in accordance with policy. Reports possible misconduct or relevant errors/ oversight in a timely manner and responsibly addresses related issues with chain of command.
  • Communication/ Interpersonal Skills: All written and oral communication skills are appropriate for their position. Consistently conveys clear, accurate, timely, and respectful communication appropriate for the situation. Informs appropriate management staff when incident occurs or a crisis situation. Interacts effectively with all levels of clients, staff, interns, volunteers and external stakeholders. Informs appropriate management staff when an incident occurs. Maintains professional boundaries with clients/residents, staff, interns, volunteers, and vendors. Able to successfully share skills and concepts with others and works effectively with others under time and environmental pressures.
  • Safety and Agency Resource Utilization: Demonstrates sound judgement and foresight in safety awareness and in daily work. Notifies, in a timely manner, the supervisory chain of any incidents or circumstances that need attention. Report all suspicions or allegations of abuse immediately to their supervisor. Ensures appropriate utilization of materials and resources and minimizes waste.

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