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Utilization Management Jobs in Illinois (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL

The Director of Case Management (Utilization Management) is responsible for the leadership, oversight, and daily operations of theUtilization Management and Case Management functions. This role ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

$37.55 - $56.33/hr

Responsibilities We are hiring a Director of Case Management (Utilization Management) at Lincoln Prairie Behavioral Health Center and offering a $5,000 sign-on bonus ! Lincoln Prairie Behavioral ...

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Utilization Management information

See Illinois salary details

$37.8K

$86.7K

$158K

How much do utilization management jobs pay per year?

As of Aug 26, 2026, the average yearly pay for utilization management in Illinois is $86,711.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,500.00 and $101,300.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Illinois?

The most popular types of Utilization Management jobs in Illinois are:

What are popular job titles related to Utilization Management jobs in Illinois?

For Utilization Management jobs in Illinois, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Illinois look for?

The top searched job categories for Utilization Management jobs in Illinois are:

What cities in Illinois are hiring for Utilization Management jobs?

Cities in Illinois with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Illinois as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $86,711 per year, or $41.7 per hour.

Utilization Management Nurse

Careers Integrated Resources Inc

Downers Grove, IL • On-site

Other

This job post has expired 6 days ago. Applications are no longer accepted.

Job description

Utilization Management Nurse

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Title: Utilization Management Nurse Consultant

Duration: 6 months (Possible ext)

Location: Downers Grove, IL

Responsibilities:

· Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

· Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

· Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

· Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license.

· Fundamental Components & Physical Requirements include but are not limited to

· (* denotes essential functions)

· Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members

· Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

· Communicates with providers and other parties to facilitate care/treatment

· Identifies members for referral opportunities to integrate with other products, services and/or programs

· Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

· Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

· Background/Experience Desired

· Managed Care experience preferred

· 3-5 years of clinical experience required

· Education and Certification Requirements

· RN consideration for LCSW) with current unrestricted state license required.

· Additional Information (situational competencies, skills, work location requirements, etc.)

· Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

· Effective communication skills, both verbal and written.

· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

· Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.

· Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

· Typical office working environment with productivity and quality expectations

· Additional for Behavioral Health:

· Experience in Behavioral Health required

· Managed Care experience preferred.

· Onsite location will be Downers Grove.

· Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months).

· The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider.

Additional Job Details :

· Required to have computer skills.

· Work with-toggle between up to 5-6 applications/systems at a time.

· Travel Required: No

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