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Utilization Review Case Manager Jobs in Chicago, IL

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

$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 ...

Veracity

UR Review Case Manager (Admin)

Chicago, IL · On-site

The 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 provides ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. * MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of ...

Sinai Health System

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 Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for utilization review case manager in Chicago, IL is $37.62, according to ZipRecruiter salary data. Most workers in this role earn between $30.48 and $39.66 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

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

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

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

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

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

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Chicago, IL as of August 2026, with employment types broken down into 58% Full Time, and 42% Contract. Highlights an 100% In-person job distribution, with an average salary of $78,179 per year, or $37.6 per hour.

Utilization Review / Case Manager (RN)

Chicago, IL • On-site

Veracity
Software Development • 1 - 10 employees
Learn more about Veracityexternal

Other

Re-posted 17 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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