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Insurance Utilization Review Jobs in Springfield, IL

Arcadia Care

Regional MDS Consultant

Springfield, IL · On-site

$110K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Extremely low-cost Health, Dental, Vision, 401K, and more * $25,000 Company Paid Life Insurance ...

Arcadia Care

Regional MDS Consultant

Lincoln, IL · On-site

$33.50 - $42.75/hr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Extremely low-cost Health, Dental, Vision, 401K, and more * $25,000 Company Paid Life Insurance ...

Arcadia Care

Regional MDS Consultant

Springfield, IL

$90K - $110K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Extremely low-cost Health, Dental, Vision, 401K, and more * $25,000 Company Paid Life Insurance ...

Arcadia Care

Regional MDS Consultant

Lincoln, IL · On-site

$110K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Extremely low-cost Health, Dental, Vision, 401K, and more * $25,000 Company Paid Life Insurance ...

Arcadia Care

Regional MDS Consultant

Lincoln, IL

$90K - $110K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Extremely low-cost Health, Dental, Vision, 401K, and more * $25,000 Company Paid Life Insurance ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Springfield, IL

Insurance Utilization Review information

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How much do insurance utilization review jobs pay per hour?

As of Sep 13, 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 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 August 2026, with employment types broken down into 1% As Needed, 69% Full Time, 25% Part Time, and 5% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.

Regional MDS Consultant

Springfield, IL • On-site

Arcadia Care
Health Care and Social Assistance • 201 - 500 employees
Learn more about Arcadia Careexternal

$110K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Arcadia Care rating

4.7

Company rating: 4.7 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

Job description

) Regional MDS Consultant
Job Summary:
The Regional MDS Consultant is responsible for the accurate and timely 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. He/she will integrate nursing, dietary, social recreation, restorative, rehabilitation and physician services to ensure appropriate assessment and reimbursement.
Essential Duties:
  • Ensures that the facility is following the organization's policy and procedures and complies with all state regulations
  • Hybrid position in Central Illinois with travel
  • Understands and implements company policies and procedures
  • Ensures the accurate and timely completion of all MDS Assessments including PPS Medicare, quarterly, annual, significant change.
  • Verifies electronic submissions of MDS, performs corrections when necessary and maintains appropriate records.
  • Coordinates interdisciplinary participation in completing the MDS for each resident according to regulatory time frames. Ensures completeness and thoroughness of documentation as mandated by federal and state standards

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:
  • Must have a current, unencumbered, active Illinois Registered Nurse License
  • Five years management experience with experience in long-term care
  • General knowledge of professional basic nursing, restoratives and personal care services

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