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Insurance Utilization Reviewer Jobs in Illinois (NOW HIRING)

UHS

Utilization Review Coordinator

Champaign, IL · On-site

$61K - $71K/yr

The information collected by the Utilization Review Coordinator will be used to contact insurance/review companies to obtain certification for the hospital stay. Benefit Highlights: * Challenging and ...

UHS

Utilization Review Coordinator

Champaign, IL · On-site

The information collected by the Utilization Review Coordinator will be used to contact insurance/review companies to obtain certification for the hospital stay. Benefit Highlights: * Challenging and ...

Skyway Behavioral Health

IL · On-site

$60K - $70K/yr

Role Description Utilization Review Specialist (URS) reports to the Utilization Review Manager and ... Serves as a liaison between clinical staff and insurance by communicating payer feedback and ...

New

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

$37.55 - $56.33/hr

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 ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

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 ...

Summit BHC

Utilization Specialist

Champaign, IL · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job ... reviews using the established hospital criteria. Communicates effectively with insurance companies ...

Summit BHC

Utilization Specialist - Acute

Champaign, IL · On-site

$3.0K/yr

Utilization Specialist - Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia About ... reviews using the established hospital criteria. Communicates effectively with insurance companies ...

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Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are popular job titles related to Insurance Utilization Reviewer jobs in Illinois?

For Insurance Utilization Reviewer jobs in Illinois, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Illinois look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Illinois are:

What cities in Illinois are hiring for Insurance Utilization Reviewer jobs?

Cities in Illinois with the most Insurance Utilization Reviewer job openings:

Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Illinois as of September 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% In-person job distribution.

Utilization Review Coordinator

Champaign, IL • On-site

UHS
Health Care and Social Assistance • 10K+ employees
Learn more about UHSexternal

$61K - $71K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 26 days ago

Key responsibilities

  • Review open charts to identify the utilization of services.

  • Contact insurance/review companies to obtain certification for hospital stays.

  • Ensure that the information collected supports the certification process.

Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 255 frontline employees who took The Breakroom Quiz

Job description

Responsibilities
Full-time Utilization Review Coordinator Opening
The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in Illinois since 1989. Located in Champaign, Illinois, we provide a secure, nurturing environment where children, adolescents, adults and senior adults can find hope and healing from emotional psychiatric and addictive diseases.
Visit us online at: www.pavilionhospital.com .
The UR Coordinator: Responsible to ensure that open charts are reviewed appropriately to identify the utilization of services. The information collected by the Utilization Review Coordinator will be used to contact insurance/review companies to obtain certification for the hospital stay.
Benefit Highlights:
  • Challenging and rewarding work environment
  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plan
  • 401(K) with company match and discounted stock plan
  • Generous Paid Time Off
  • Career development opportunities within UHS and its 300+ Subsidiaries

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 were over $11 billion in 2020. In 2021, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of U.S.' Largest Public Companies. Headquartered in King of Prussia, PA, UHS has over 89,000 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 all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhsinc.com
Qualifications
Master's degree in the human services field (counseling, psychology, social work) or RN licensure within Illinois required. Previous professional experience in a behavioral health setting preferred.
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.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

What Universal Health Services employees say

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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

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