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Manager Utilization Management Jobs in Spring Grove, IL

Humana

Onsite Care Coordination Nurse

Buffalo Grove, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Buffalo Grove, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Gurnee, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Mundelein, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Lake Zurich, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Buffalo Grove, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Humana

Onsite Care Coordination Nurse

Waukegan, IL · On-site

Previous Utilization Management Experience * Previous health plan experience * Bilingual (English/Spanish) preferred * Certification in Care Management or related specialty * Knowledge of HEDIS and ...

Crunch Fitness

General Manager

IL · On-site

$60K/yr

Direct management of team, including setting weekly management schedules and assigning areas of ... Command of all offerings, amenities, and equipment utilization. * Ensure and monitor compliance and ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Spring Grove, IL

Manager Utilization Management information

See Spring Grove, IL salary details

$39.2K

$91.4K

$168.2K

How much do manager utilization management jobs pay per year?

As of Sep 13, 2026, the average yearly pay for manager utilization management in Spring Grove, IL is $91,389.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,700.00 and $110,000.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What cities near Spring Grove, IL are hiring for Manager Utilization Management jobs?

Cities near Spring Grove, IL with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Spring Grove, IL as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution, with an average salary of $91,389 per year, or $43.9 per hour.

Onsite Care Coordination Nurse

Buffalo Grove, IL • On-site

Humana
Health Care and Social Assistance • 10K+ employees
Learn more about Humanaexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

Key responsibilities

  • Conduct face-to-face assessments of newly admitted members at acute care facilities to evaluate their physical, psychosocial, and health needs.

  • Support and educate members and families on discharge planning, including facilitating follow-up visits with primary care providers.

  • Collaborate with healthcare professionals to ensure timely, coordinated care and develop strategies to address gaps in care and discharge barriers.

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 267 frontline employees who took The Breakroom Quiz

Job description

Become a part of our caring community
At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members during critical moments in their care journey-serving as a trusted clinical partner within acute care settings.
In this role, you'll provide face-to-face assessments and lead care coordination efforts for newly admitted members, helping ensure smooth, safe, and timely transitions from hospital to home. By identifying gaps in care and collaborating with providers and care teams, you will directly contribute to improving health outcomes and reducing unnecessary readmissions.
This is an opportunity for a nurse who is passionate about whole-person care, thrives in an autonomous environment, and values meaningful connections with members and colleagues. The role offers a hybrid work model, combining in-person engagement at assigned facilities with the flexibility to complete coordination and documentation remotely.

Key Responsibilities

  • Conduct comprehensive, face to face assessments of newly admitted members at assigned acute care facilities to evaluate physical, psychosocial, and health needs; refer to Humana programs as appropriate.
  • Support and educate members and families on discharge planning from admission through post-discharge, including facilitating follow-up visits with primary care providers.
  • Identify gaps in care, safety concerns, and barriers to discharge; develop and implement strategies to address these issues.
  • Collaborate with attending providers, facility case managers, and other healthcare professionals to ensure timely, coordinated care and effective discharge planning.
  • Provide education on diagnoses, medications, and preventive measures to promote ongoing wellness and reduce risk of readmission.
  • Complete all required documentation accurately and promptly.
  • Maintain adherence to infection control, safety, and patient privacy standards at all times.

Onsite Location

** This is an Onsite / Hybrid position at the (Advocate Condell Medical Center - 801 S Milwaukee Ave) located in (Libertyville, Illinois). The ideal candidate must live within a reasonable commute to the facility preferably no more than a 30-60 minute driving distance to the Onsite location from their home base.**

**This position will work at an Onsite facility and as a Hybrid; will have limited working hours at home based on the leader's discretion. **


Use your skills to make an impact

Required Qualifications

  • Current, unrestricted Registered Nurse (RN) license in the state of Illinois
  • Must be Located within a 30-60 minute driving distance to (Advocate Condell Medical Center - 801 S Milwaukee Ave) from your home base
  • Minimum of 3 years recent acute care nursing experience (e.g., medical-surgical, critical care, heart/lung, skilled nursing, or rehabilitation)
  • Experience with discharge planning or care coordination in a hospital or health plan settings
  • Experience in Microsoft Office applications (Word, Outlook, Excel) and electronic medical records
  • Valid driver's license, dependable automobile, and proof of personal vehicle liability insurance

Preferred Qualifications

  • Bachelor's degree in Nursing (BSN)
  • Experience in care management, health promotion, or coaching
  • Previous Utilization Management Experience
  • Previous health plan experience
  • Bilingual (English/Spanish) preferred
  • Certification in Care Management or related specialty
  • Knowledge of HEDIS and Stars measures

Work Schedule

  • Monday through Friday, 8:00 AM - 5:00 PM local time- This position does not require holidays, on-call or weekends

Additional Requirements

  • Participation in Tuberculosis (TB) screening and ACHA Level II background clearance (including fingerprinting), as required by state and company policy
  • Other credentialing and screening as required by assigned facility
  • Must have a private workspace for remote documentation when not in the field
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$71,100 - $97,800 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

Social media

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