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Utilization Review Jobs in Chicago, IL (NOW HIRING)

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 ...

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 · 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

Transfer RN/UR

Chicago, IL · On-site

$70K/yr

Utilization Review Experience (Preferred) * Full time 11am-7 pm * Experience with Cerner (Preferred) * Excellent communication and organizational skills * Assesses, develops, facilitates, and ...

Insight

Transfer RN/UR

Chicago, IL · On-site

$70K/yr

Utilization Review Experience (Preferred) * Full time 11am-7 pm * Experience with Cerner (Preferred) * Excellent communication and organizational skills * Assesses, develops, facilitates, and ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Chicago, IL

Utilization Review information

See Chicago, IL salary details

$22

$43

$71

How much do utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review in Chicago, IL is $43.59, according to ZipRecruiter salary data. Most workers in this role earn between $34.47 and $50.05 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Chicago, IL?

The most popular types of Utilization Review jobs in Chicago, IL are:

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

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

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Chicago, IL as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $90,598 per year, or $43.6 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 8 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

1,053rd 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

Workplace

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