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Utilization Case Manager Jobs in Aurora, IL (NOW HIRING)

Sinai Health System

RN Case Manager

Chicago, IL

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 ...

Elgin Inpatient

Clinical Case Manager

Elgin, IL

$50K - $55K/mo

Position Overview The Case Manager is responsible for supporting clinical, non-clinical, and ... Provides ASAM-specific reviews as needed and reports findings to the Utilization Review Specialist ...

Guardian Angel Community Services

Case Manager

Joliet, IL · On-site

$19.75 - $25.50/hr

... care case records on children and families served. 3. Advise and consult with foster parents to ... utilization of available resources to address the service goals of the cases assigned. 6. Submit ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Aurora, IL

Utilization Case Manager information

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How much do utilization case manager jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization case manager in Aurora, IL is $36.17, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $38.12 per hour, depending on experience, location, and employer.

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

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Aurora, IL?

For Utilization Case Manager jobs in Aurora, IL, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Aurora, IL look for?

The top searched job categories for Utilization Case Manager jobs in Aurora, IL are:

What cities near Aurora, IL are hiring for Utilization Case Manager jobs?

Cities near Aurora, IL with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

Utilization Review / Case Manager (RN)

Veracity

Chicago, IL • On-site

Other

Re-posted 26 days ago

Job description

Title: Utilization Review / Case Manager (RN)
Chicago, Illinois
Reports To: Clinical Director, Behavioral Health Services
Term: Permanent, Full-time
General Summary
The Utilization Review/Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner. The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.
Key Responsibilities
Utilization Management
  • Perform inpatient utilization management per plan, payer requirements, and standards.
  • Collaborate with physicians and healthcare team members for timely and appropriate patient management.
  • Collect and document clinical data to support admission and continued hospitalization.
  • Provide accurate clinical information to payers as required.
  • Support DRG Assurance Program with accurate data collection and assignment.
  • Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed.
Discharge Planning
  • Participate in family meetings and care conferences.
  • Ensure timely referrals for discharge planning and use of regional/community resources.
  • Refer complex cases to Social Services as appropriate.
  • Ensure psychological needs of patients are met via direct intervention or referral.
Communication & Coordination
  • Act as a central communicator with patients, families, vendors, payers, and hospital staff.
  • Provide continuity of care by leveraging community resources and maintaining updated resource manuals.
  • Refer cases not meeting criteria to Physician Advisor in a timely manner.
  • Follow up with Medical Director/Physician Advisor on unresolved issues.
Other Duties
  • Maintain safe patient care environment and infection control compliance.
  • Manage departmental operations (phones, supplies, data tracking).
  • Attend in-service presentations and complete all mandatory education.
  • Perform other duties as assigned.

Knowledge, Skills & Abilities
  • Graduate of an accredited school of nursing (Required)
  • Current RN License in Illinois (Required)
  • 2+ years relevant clinical experience (Preferred)
  • Utilization management experience (Preferred)
  • Knowledge of Medicare/Medicaid, Managed Care, and Commercial insurance processes (Preferred)
  • Strong written/oral communication skills with appropriate grammar and vocabulary
  • Proficiency in Microsoft Word and Excel (Required)
  • Ability to provide excellent customer service at all times
  • Ability to anticipate and coordinate multiple functions effectively

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