ZipRecruiter

Log In

1

Insurance Utilization Review Jobs in Springfield, IL

previous page

Showing results 41-60

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

Insurance Utilization Review information

See Springfield, IL salary details

$21

$41

$68

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 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, 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.

Patient Access Specialist - PRN

Ensemble Health Partners

Springfield, IL • On-site

$17 - $18.15/hr

Per diem

This job post has expired today. Applications are no longer accepted.

Ensemble Health Partners rating

6.6

Company rating: 6.6 out of 10

Based on 246 frontline employees who took The Breakroom Quiz

139th of 151 rated financial services

Job description

Job Description

ENTRY LEVEL CAREER OPPORTUNITY OFFERING:

  • Bonus Incentives

  • Paid Certifications

  • Tuition Reimbursement

  • Comprehensive Benefits

  • Career Advancement

  • This position pays between $17.00 - $18.15/hr based on experience

***This position is an onsite role and candidates must be able to work on-site at HSHS- St. Johns Hospital, Springfield, IL****

We are searching for the next Patient Access Specialist champion. This role is responsible for performing admitting duties for all patients admitted for services at the hospital. They are responsible for performing these functions while meeting the mission and goals of the organization and all regulatory compliance requirements. The Representative will work within the policies and processes as they are being performed across the entire organization.

Job Responsibilities:

  • The Patient Access Representative is responsible for performing admitting duties for all patients admitted for services at the hospital. They are responsible for performing these functions while meeting the mission and goals of the organization and all regulatory compliance requirements. The Representative will work within the policies and processes as they are being performed across the entire organization.

  • Responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving and processing physician orders, and utilizing a overlay tool while providing excellent customer service as measured by Press Ganey.

  • Operates the telephone switchboard to relay incoming, out-going and inter-office calls as applicable. They are to adhere to policies, and provide excellent customer service in these interactions with the appropriate level of compassion. Patient Access staff will be held accountable for point of service goals as assigned.

  • Responsible for the utilization of quality auditing and reporting systems to ensure accounts are corrected. These activities may include accounts for other employees, departments, and facilities. Conducts audits of accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access leadership.

  • Responsible for the pre-registration of patient accounts prior to patient visits. This may include inbound and outbound calling to obtain demographic, insurance, and other patient information including the patient financial liabilities including collecting point of service collections as well as past due balances including payment plan options.

  • Explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witnesses name.

  • Explains and distributes patient education documents, such as Important Message from Medicare, Important Message from Tricare, Observation Forms, MOON form, Consent forms, and all forms implemented for future services.

  • Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate.

  • Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other designated forms and pamphlets.

Experience:

  • 1+ years of customer service experience

  • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Required Education:

  • High School Diploma/GED Required

Certification:

  • CRCR Required within 6 months of hire (Company Paid)

What Ensemble Health Partners employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom