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Senior Rn Utilization Review Nurse Jobs in Springfield, IL

Memorial Health

Utilization Review RN

Springfield, IL · On-site

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Memorial Health

Utilization Review RN

Springfield, IL

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Memorial Health

Utilization Review RN

Springfield, IL · On-site

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Memorial Health

Registered Nurse (RN), Cath Lab

Harvel, IL · On-site

$48.37/hr

... utilization of the nursing process. Provides age-appropriate care. Participates in research when ... Sandy Dunn, Senior Talent Acquisition Partner Dunn.Sandy@mhsil.com To review Memorial's Benefits ...

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Senior Rn Utilization Review Nurse information

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$41

$68

How much do senior rn utilization review nurse jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for senior rn utilization review nurse 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 the difference between Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by Senior RN Utilization Review Nurses when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.
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What cities near Springfield, IL are hiring for Senior Rn Utilization Review Nurse jobs? Cities near Springfield, IL with the most Senior Rn Utilization Review Nurse job openings:
Senior Rn Utilization Review Nurse jobs near you
Infographic showing various Senior Rn Utilization Review Nurse job openings in Springfield, IL as of June 2026, with employment types broken down into 1% As Needed, 71% Full Time, 7% Part Time, and 21% Contract. Highlights an 86% Physical, 5% Hybrid, and 9% Remote job distribution, with an average salary of $87,164 per year, or $41.9 per hour.
Utilization Review RN

Utilization Review RN

Memorial Health

Springfield, IL • On-site

$32.95 - $52.73/hr

Full-time

Posted 10 days ago

Memorial Health rating

6.8

Company rating: 6.8 out of 10

Based on 170 frontline employees who took The Breakroom Quiz

485th of 870 rated healthcare providers

Job description

Min
USD $32.95/Hr.
Max
USD $52.73/Hr.
Overview
Shift: 12pm - 12am or 8:00-4:30pm
Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services.
This is NOT a remote position.
Qualifications
Education:
Associates Degree in Nursing. Bachelor's Degree in Nursing preferred.
Evidence of continuing professional development
Licensure/Certification/Registry:
Current RN licensure in the State of Illinois required
Experience:
Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review experience strongly preferred.
Other Knowledge/Skills/Abilities:
Understanding of healthcare reimbursement mechanisms preferred.
Strong oral and written communication skills.
Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes
Understanding of the principles of performance improvement, team collaboration, and conflict resolution

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