ZipRecruiter

Log In

1

Insurance Utilization Reviewer Jobs in Illinois (NOW HIRING)

Ourhrconnect

Medical Review Supervisor

Virginia, IL · On-site +1

We are the largest insurance company in South Carolina ... and much more. We are one of the nation ... Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review ...

Ourhrconnect

Medical Review Supervisor

Tennessee, IL · On-site +1

We are the largest insurance company in South Carolina ... and much more. We are one of the nation ... Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review ...

Ourhrconnect

Medical Review Supervisor

Tennessee, IL · On-site +1

We are the largest insurance company in South Carolina ... and much more. We are one of the nation ... Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review ...

New

Ourhrconnect

Medical Review Supervisor

Virginia, IL · On-site +1

We are the largest insurance company in South Carolina ... and much more. We are one of the nation ... Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review ...

New

Veracity

UR Review Case Manager (Admin)

Chicago, IL · On-site

... utilization management experience preferred. • Knowledge of Medicare/Medicaid, Managed Care and Commercial insurance review processes preferred. • Ability to proactively anticipate and coordinate ...

GQR Global Markets

RN Case Manager

Mattoon, IL · On-site

$1.9K - $2.0K/wk

Case Management/Utilization Review Shift: Day Shift Details: null Day Job Type: Travel Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new ...

GQR

RN - Case Manager

Mattoon, IL · On-site

$1.9K - $2.0K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mattoon ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

Memorial Health

Insurance Pre-Auth Spec I

Lincoln, IL

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Memorial Health

Insurance Pre-Auth Spec I

Lincoln, IL

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Memorial Health

Insurance Pre-Auth Spec I

Lincoln, IL · On-site

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Memorial Health

Insurance Pre-Auth Spec I

Lincoln, IL · On-site

$16.50 - $24.82/hr

... utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and ... The specialist also supports concurrent review processes for patients actively receiving care.

Morris Hospital

MANAGER CASE MANAGEMENT

Morris, IL · On-site

$19.50 - $25/hr

Two years previous experience in case management/utilization review. * Certification in Case ... vesting - Life insurance - Disability coverage - Nurse residency program - Wellness program ...

previous page

Showing results 41-60

All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Illinois

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 August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 86% In-person, 9% Hybrid, and 5% Remote job distribution.

Medical Director Utilization Management Oncology

Starling Oncology

Chicago, IL • Remote

$275K - $325K/yr

Full-time

Posted 29 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.

 Key Responsibilities:

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
  • Partner with clinical and operational teams to support value-based care.
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.

Qualifications:

  • Medical degree (MD or DO)
  • Board Certification in Oncology.
  • Minimum of 5 years of clinical experience in oncology.
  • 2+ years of Utilization Management experience
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$275,000—$325,000 USD