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Utilization Review Coordinator Jobs in Springfield, IL

The Utilization Review Director oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management ...

The Utilization Review Director o versees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management ...

Credit Review Manager

Chatham, IL · On-site

$110K - $150K/yr

Assures effective utilization of supervised staff * Perform daily administrative tasks to ensure ... coordination of the department's activities and the Bank's loan files * Develop and maintain ...

Credit Review Manager

Chatham, IL · On-site

$110K - $150K/yr

Assures effective utilization of supervised staff * Perform daily administrative tasks to ensure ... coordination of the department's activities and the Bank's loan files * Develop and maintain ...

... utilization review processes, coordinating vendor referrals, and assisting with subpoenas, liens, and claim file management activities. Responsibilities * Organizes the digital claim records for ...

Claims Assistant

Springfield, IL · On-site

$17 - $19/hr

... utilization review processes, coordinating vendor referrals, and assisting with subpoenas, liens, and claim file management activities. Responsibilities * Organizes the digital claim records for ...

MDS CAREPLAN COORDINATOR

Springfield, IL · On-site

$30.25 - $45/hr

) MDS / Care Plan Coordinator Job Summary: The MDS / Care Plan Coordinator is responsible for ... Set (MDS) reviews to assure achievement of optimal allowable Resource Utilization Group (RUG ...

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Utilization Review Coordinator information

See Springfield, IL salary details

$15

$29

$46

How much do utilization review coordinator jobs pay per hour?

As of Aug 1, 2026, the average hourly pay for utilization review coordinator in Springfield, IL is $29.34, according to ZipRecruiter salary data. Most workers in this role earn between $21.20 and $34.33 per hour, depending on experience, location, and employer.

How does a Utilization Review Coordinator typically collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

Is utilization review work from home?

Utilization Review Coordinators often have the option to work remotely, especially in organizations that support telecommuting. However, some employers may require in-office presence for certain tasks or meetings, and remote work policies can vary by company and role requirements. Strong communication skills and familiarity with electronic health records are important for remote utilization review work.

What degree do I need for utilization review?

Utilization Review Coordinators typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some positions may require a registered nurse (RN) license or relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ). Experience in medical coding, insurance, or clinical settings can also be beneficial.

What does a utilization management coordinator do?

A utilization management coordinator reviews medical records and treatment plans to ensure they meet insurance and healthcare guidelines. They assess the necessity and appropriateness of services, often using healthcare management software, to facilitate approval or denial of claims and support cost-effective patient care. Strong knowledge of healthcare policies and attention to detail are essential for this role.

What does a Utilization Review Coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

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

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

What is the highest paying job as a coordinator?

The highest paying roles for utilization review coordinators often include senior or managerial positions such as Utilization Review Manager or Director, which can offer higher salaries due to increased responsibilities and experience requirements. Advanced certifications like Certified Professional in Healthcare Quality (CPHQ) or extensive experience can also lead to higher compensation within the field.
What are the most commonly searched types of Utilization Review jobs in Springfield, IL? The most popular types of Utilization Review jobs in Springfield, IL are:
What are popular job titles related to Utilization Review Coordinator jobs in Springfield, IL? For Utilization Review Coordinator jobs in Springfield, IL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Coordinator jobs in Springfield, IL look for? The top searched job categories for Utilization Review Coordinator jobs in Springfield, IL are:
What cities near Springfield, IL are hiring for Utilization Review Coordinator jobs? Cities near Springfield, IL with the most Utilization Review Coordinator job openings:
Infographic showing various Utilization Review Coordinator job openings in Springfield, IL as of July 2026, with employment types broken down into 1% As Needed, 75% Full Time, 21% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 3% Hybrid, and 3% Remote job distribution, with an average salary of $61,037 per year, or $29.3 per hour.

DIR - UTILIZATION REVIEW / MGMT

UHS

Springfield, IL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago


Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 253 frontline employees who took The Breakroom Quiz

492nd of 887 rated healthcare providers


Job description

Responsibilities

Lincoln Prairie Behavioral Health Center is a 97-bed facility located in Springfield, Illinois. We are dedicated to providing youth with compassionate mental health treatment that encourages self-responsibility and personal growth. We are the only facility of our kind in Central Illinois! We provide psychiatric treatment to children and adolescents that present with a broad range of psychiatric and behavioral disorders. A clinically skilled multidisciplinary team works to partner with the youth and family to accomplish their goals in a supportive and therapeutic environment.

The Utilization Review Director oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.


Qualifications

Duties and Responsibilities:

  • Oversees all utilization management functions.
  • Oversees precertification, concurrent, and discharge utilization reviews.
  • Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources.
  • Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results.
  • Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements.
  • Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight.
  • Directs utilization management staff and performs all administrative department head functions.
  • Oversees the Utilization Management committee structure. Develops and monitors utilization management plans.

Benefit & Rewards Highlights

  • Retention Bonus Program
  • Loan Forgiveness Program
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Tuition savings
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • Pet Insurance
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

Requirements:

  • Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.

  • Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines.

  • Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations.

  • Excellent oral and written communication skills that drive departmental hospital engagement.

  • 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.

  • Education: Master's Degree required
  • Registered Nurse License required
  • Social Work, Marriage and Family, Mental Health Counseling (i.e. LPC, LMHC, LCSW, LCPC, LPCC) preferred

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Qualifications:

Duties and Responsibilities:

  • Oversees all utilization management functions.
  • Oversees precertification, concurrent, and discharge utilization reviews.
  • Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources.
  • Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results.
  • Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements.
  • Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight.
  • Directs utilization management staff and performs all administrative department head functions.
  • Oversees the Utilization Management committee structure. Develops and monitors utilization management plans.

Benefit & Rewards Highlights

  • Retention Bonus Program
  • Loan Forgiveness Program
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Tuition savings
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • Pet Insurance
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

Requirements:

  • Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation.

  • Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines.

  • Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations.

  • Excellent oral and written communication skills that drive departmental hospital engagement.

  • 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.

  • Education: Master's Degree required
  • Registered Nurse License required
  • Social Work, Marriage and Family, Mental Health Counseling (i.e. LPC, LMHC, LCSW, LCPC, LPCC) preferred

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Education:UNAVAILABLEEmployment Type: FULL_TIME

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Pay

Benefits

Hours and flexibility

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Universal Health Services logo

About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US