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Utilization Review Manager Jobs in Illinois (NOW HIRING)

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 ...

United Community Bank

Credit Review Manager

Chatham, IL

$110K - $150K/yr

Assures effective utilization of supervised staff * Perform daily administrative tasks to ensure ... Credit review examiner in charge experience preferred * 2 years of prior management experience ...

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 ...

AltaStaff

UM Care Review Clinician

Chicago, IL · On-site

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care. * Assess and analyze ...

AltaStaff, LLC

UM RN Care Review Clinician

Chicago, IL · Remote

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care. * Assess and analyze ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Illinois

Utilization Review Manager information

See Illinois salary details

$37.8K

$88.2K

$162.3K

How much do utilization review manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization review manager in Illinois is $88,192.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,700.00 and $106,100.00 per year, depending on experience, location, and employer.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

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

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

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

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

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

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

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

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

What cities in Illinois are hiring for Utilization Review Manager jobs?

Cities in Illinois with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Illinois as of August 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, 5% Hybrid, and 5% Remote job distribution, with an average salary of $88,192 per year, or $42.4 per hour.

Case Manager - Utilization Review RN

Community First Medical Center

Chicago, IL • On-site

$43.47 - $53/hr

Full-time, Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 7 days ago

Key responsibilities

  • Perform concurrent utilization review and medical necessity determination to support appropriate hospital resource use.

  • Coordinate discharge planning and care transitions to ensure safe patient transfers and compliance with regulations.

  • Collaborate with physicians, interdisciplinary team members, and payers to optimize utilization, reimbursement, and regulatory adherence.

Community First Medical Center rating

3.9

Company rating: 3.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

1,052nd of 1,065 rated hospitals

Job description

Description:

Under the general direction of the Director of Behavioral Health, the Case Manager – Utilization Review RN provides clinically based case management and utilization review services to support the delivery of high-quality, cost-effective patient care. The RN is responsible for concurrent utilization review, medical necessity determination, denial prevention, discharge planning, care coordination, and resource management across the continuum of care.

The Case Manager – Utilization Review RN collaborates with physicians, interdisciplinary team members, physician advisors, social workers, revenue cycle staff, and third-party payers to ensure appropriate utilization of hospital resources, regulatory compliance, optimal reimbursement, and safe patient transitions.


  Community First Medical Center offers benefits to all its full-time and part-time employees:          

  • United Healthcare Medical PPO/HMO/HSA Plans, premiums as low as $50.00/full time, $85.00/Part Time
  • Met Life Dental and Vision
  • Paid Time Off  (PTO) with annual accruals up to 168 hrs./year
  • Six paid holidays
  • Company Paid Life insurance and Short-term Disability 
  • 401(k) after 90 days
  • Continuing Education reimbursement and 2 days paid off separate from PTO
  • Free Parking Garage
  • Internal Growth Opportunities


Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

QUALIFICATIONS

Education

  • Associate Degree in Nursing required.
  • Bachelor of Science in Nursing (BSN) preferred.  

Experience

  • Minimum three (3) years of acute care nursing experience required.
  • Minimum two (2) years of Case Management and/or Utilization Review experience preferred.
  • Experience with discharge planning, utilization review, denial management, and payer authorization preferred.

Licensure

  • Current Illinois Registered Nurse license required.
  • ACM, CCM, or CMAC certification preferred.

KNOWLEDGE, SKILLS & ABILITIES

  • Knowledge of Medicare, Medicaid, and commercial insurance regulations.
  • Working knowledge of InterQual and/or MCG criteria.
  • Behavioral Health background knowledge
  • Access to Behavioral Health Networks 
  • Understanding of utilization management and care coordination principles.
  • Knowledge of discharge planning and post-acute care resources.
  • Strong analytical and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Ability to prioritize multiple complex patient cases.
  • Ability to build collaborative relationships with physicians and interdisciplinary teams.
  • Computer proficiency and electronic medical record experience.

PERFORMANCE EXPECTATIONS

Success in this role is measured by:

  • Appropriate admission status determination
  • Denial prevention and appeal success
  • Timely discharge planning 
  • Reduction in avoidable days
  • Average Length of Stay management
  • Readmission reduction
  • Documentation compliance
  • Regulatory compliance
  • Patient throughput
  • Patient and physician satisfaction

What Community First Medical Center employees say

Pay

Hours and flexibility

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