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Utilization Case Manager Jobs in Illinois (NOW HIRING)

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 ...

Encompass Health Corporation

Case Manager

Moline, IL · On-site

$18.50 - $23.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health Corporation

Case Manager

Libertyville, IL · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...

Encompass Health

Case Manager

Libertyville, IL

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Libertyville, IL

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Moline, IL

$18 - $23.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Sinai Chicago

RN Case Manager

Chicago, IL · On-site

The RN Case manager provides education to physicians and other members of the team on the issues related to utilization review including appropriateness of admission, level of care and external ...

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Utilization Case Manager information

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Illinois? For Utilization Case Manager jobs in Illinois, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Illinois look for? The top searched job categories for Utilization Case Manager jobs in Illinois are:
What cities in Illinois are hiring for Utilization Case Manager jobs? Cities in Illinois with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Illinois as of July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Utilization Management/Case Manager

Accolade Health Care

Champaign, IL

$75K - $90K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 2 days ago

Job description

Accolade Healthcare

Utilization Management/Case Manager

About Us

At Accolade Healthcare, we put an emphasis on the satisfaction of our team members, understanding that a foundation built on quality patient care starts with the people providing the care. Our goal is to care for our staff with respect, empathy, and appreciation. Providing our professional staff with safe and efficient equipment to complete their mission is our priority. Accolade is committed to never being satisfied with industry norms and standards – instead, always searching for creative methods to equip our team with the tools necessary to achieve success.

 

Job Summary

As a  Utilization Management/Case Manager at Accolade Healthcare, you will be responsible for coordinating the continuum of care for patients, with a strong focus on insurance authorizations, case management, and discharge planning. This role is vital to ensure that services are covered, appropriately authorized, and effectively managed to achieve optimal patient and financial outcomes.

Pay: $75,000-$90,000 annually

Benefits:

·        Medical, Dental, Vision and additional other voluntary benefits

·        401k with company match

·        Generous Paid Leave Policy 

·        Daily Pay partner

Responsibilities:

As a Utilization Management/Case Manager, your responsibilities include:

·       Coordinate and manage care for a caseload of SNF patients, ensuring timely authorizations and continued stay approvals.

·       Collaborate with interdisciplinary care teams, including physicians, therapists, social workers, and payors, to promote seamless transitions and quality care.

·       Obtain and manage insurance authorizations for inpatient SNF care, including commercial plans, Medicare Advantage, Medicaid, Workman’s Compensation, No-Fault, and Single Case Agreements (SCA).

·       Negotiate reimbursement rates for non-contracted payors when necessary.

·       Review and respond to denials and discrepancies in authorizations; prepare appeal documentation and participate in QIO or health plan-level appeals as needed.

·       Identify patient care needs, assess insurance limitations, and work with the healthcare team to develop appropriate care plans.

·       Advocate for patient access to appropriate services while maintaining compliance with insurance guidelines.

·       Maintain accurate and up-to-date documentation in accordance with facility, insurance, and regulatory standards.

 

Skills and Qualifications:

To excel as a Utilization Management/Case Manager, you will need:

·       Licensed Registered Nurse (RN) or equivalent clinical credential preferred.

·       Minimum 2 years of case management experience, preferably in a SNF, hospital, or managed care setting.

·       Strong knowledge of insurance authorization processes, managed care, and appeal strategies.

·       Experience with Single Case Agreements, Workman’s Comp, and No-Fault contracts.

·       Excellent communication, negotiation, and interdisciplinary collaboration skills.

·       Proficient in electronic health records and case management software.

·       Familiarity with CMS guidelines, QIO processes, and discharge planning protocols.

·       Ability to manage a high-volume caseload with a proactive and organized approach.

·       Knowledge of Medicare and Medicaid regulations specific to SNFs.

On-site or hybrid work environment depending on facility needs.

Fast-paced, patient-centered setting with frequent interaction with healthcare professionals and insurance representatives.