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Manager Optum Utilization Review Jobs in Chicago, IL

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. * MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of ...

Clarity Clinic

Utilization Review Clinician

Chicago, IL · On-site

We offer a broad range of specialties and treatment approaches - including medication management ... The Utilization Review Clinician owns the clinical utilization review function for Clarity Clinic ...

Clarity Clinic

Utilization Review Clinician

Chicago, IL · On-site

We offer a broad range of specialties and treatment approaches - including medication management ... The Utilization Review Clinician owns the clinical utilization review function for Clarity Clinic ...

Ascension

Registered Nurse Utilization Review

Chicago, IL · On-site

$52 - $55/hr

Manage payer denials and appeals by reviewing technical denials, determining appeal eligibility, preparing appeal correspondence, and tracking outcomes to support reimbursement efforts. * Coordinate ...

Insight

ED UTILIZATION REVIEW/CASE MANAGER

Chicago, IL · On-site

$85K - $90K/yr

The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and ...

Insight

ED UTILIZATION REVIEW/CASE MANAGER

Chicago, IL · On-site

$85K - $90K/yr

The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and ...

AltaStaff, LLC

UM RN Care Review Clinician

Chicago, IL · Remote

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care. * Assess and analyze ...

AltaStaff

UM Care Review Clinician

Chicago, IL · On-site

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care. * Assess and analyze ...

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Manager Optum Utilization Review information

See Chicago, IL salary details

$40.2K

$93.8K

$172.6K

How much do manager optum utilization review jobs pay per year?

As of Aug 30, 2026, the average yearly pay for manager optum utilization review in Chicago, IL is $93,755.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,300.00 and $112,800.00 per year, depending on experience, location, and employer.

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

What are the key skills and qualifications needed to thrive as a manager Optum Utilization Review, and why are they important?

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

What are the most commonly searched types of Optum Utilization Review jobs in Chicago, IL?

The most popular types of Optum Utilization Review jobs in Chicago, IL are:

What are popular job titles related to Manager Optum Utilization Review jobs in Chicago, IL?

For Manager Optum Utilization Review jobs in Chicago, IL, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Chicago, IL look for?

The top searched job categories for Manager Optum Utilization Review jobs in Chicago, IL are:

What cities near Chicago, IL are hiring for Manager Optum Utilization Review jobs?

Cities near Chicago, IL with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Chicago, IL as of August 2026, with employment types broken down into 2% As Needed, 84% Full Time, 10% Part Time, 2% Temporary, and 2% Contract. Highlights an 89% In-person, 2% Hybrid, and 9% Remote job distribution, with an average salary of $93,755 per year, or $45.1 per hour.

Utilization Review Nurse

Chicago, IL • On-site

US Tech Solutions
IT Services • 1 - 5K employees
Learn more about US Tech Solutionsexternal

Other

Re-posted 6 days ago

Job description

Chicago, IL

Contract

Job Description:

  • Participates in the development and ongoing implementation of QM Work Plan activities.

  • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives

Responsibilities:

  • Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.

  • Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.

  • Data gathering requires navigation through multiple system applications.

  • Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

  • Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.

  • Responsible for the review and evaluation of clinical information and documentation.

  • Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.

  • Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).

  • Independently coordinates the clinical resolution with internal/external clinician support as required.

  • Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data

  • Prepares and completes QM documents based on interpretation and application of business requirements

  • Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements

  • Assists in the development and implementation of QM projects and activities

  • Accountable for completing and implementation of QM Work Plan Activities

Experience:

  • 3+ years of experience as an RN

  • Registered Nurse in state of residence

  • Must have prior authorization utilization experience

  • Experience with Medcompass

Skills:

  • MUST HAVE MEDCOMPASS or ASSURECARE exp.

  • MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.

  • MUST HAVE UM experience, inpatient utilization management review.

  • MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.

  • MUST HAVE 6 months of Prior Authorization.

Education:

  • Active and unrestricted RN licensure in state of residence

Questionnaire:

  • Do you have experience with Medcompass?

  • Do you have experience with Prior Authorization?

  • Do you have experience with Utilization Review?

  • Do you have an Active Registered Nurse License?

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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About US Tech Solutions

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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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