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Insurance Utilization Review Jobs in Springfield, IL

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How much do insurance utilization review jobs pay per hour?

As of Jul 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
Infographic showing various Insurance Utilization Review job openings in Springfield, IL as of July 2026, with employment types broken down into 1% As Needed, 70% Full Time, 25% Part Time, and 4% 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.

MDS CAREPLAN COORDINATOR

Avenues at Springfield

Springfield, IL

$30.25 - $45/hr

Full-time

Posted 8 days ago

Job description

MDS / Care Plan Coordinator

Job Summary:

The MDS / Care Plan Coordinator is responsible for assuring the timely completion of accurate resident assessments and interdisciplinary care plans that meet Federal and State guidelines. This includes identifying resident acuity and needs, helping to determine specific care needs, and communicating needs and expectations to families and responsible parties.

Essential Duties:

· Responsible for integrating nursing, dietary, social recreation, restorative, rehabilitation, and physician services to ensure appropriate assessment and reimbursement.

· Responsible for completion of all Medicare/Medicaid case-mix documents to assure appropriate reimbursement for care and services provided within the Facility.

· Conducts continual Minimum Data Set (MDS) reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category.

· Oversees the overall process and tracking of MDS/Prospective Payment System (PPS) documentation and submission.

Benefits Offered:

  • Extremely low-cost Health, Dental, Vision, 401K, and more

  • $25,000 Company Paid Life Insurance – at no cost to you

  • Leadership Training to enhance your management skills

  • Daily Pay - get your money when you want

  • Paid Vacations - rolls over each year

  • Paid Sick Time

  • Paid Holidays

  • Tuition Reimbursement

  • Daily, Weekly, Monthly Employee Appreciation Events

  • Birthday, Anniversary Celebrations

  • Free Employee Assistance Programs - professional support & guidance on family, money, health, legal services and more

  • Huge Discounts at all major retailers (Walmart, Costco, etc.) at no cost to you

  • Virtual Visits with Doctors 24/7, without setting up additional accounts or appointments

  • Paid Break Time for Nursing Mothers

  • Time Off to Vote

Preferred Qualifications:

· Registered Nurse with current unencumbered state licensure.

· Long Term Care Experience preferred.

· Ability to read, write, speak, and understand the English language.

#ACS NRS