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Utilization Review Jobs in Chicago, IL (NOW HIRING)

UCAN

QI Coordinator

Chicago, IL · On-site

Coordinates utilization review process; including random selection of files; and scheduling. * Conducts utilizations reviews. * Provides feedback to agency programs regarding compliance with ...

UCAN

QI Coordinator

Chicago, IL · On-site

$46K - $50K/yr

Coordinates utilization review process; including random selection of files; and scheduling. * Conducts utilizations reviews. * Provides feedback to agency programs regarding compliance with ...

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Utilization Review information

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$22

$43

$71

How much do utilization review jobs pay per hour?

As of Sep 5, 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.

Utilization Management and Population Health Nurse

Humboldt Park Health

Chicago, IL • On-site

Full-time

Re-posted 22 days ago

Humboldt Park Health rating

5.4

Company rating: 5.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

952nd of 1,065 rated hospitals

Job description

  • Utilization case review and application of criteria to approve initial and continued inpatient services
  • Identify patients in need of outreach efforts based on patient risk stratification or other defined criteria as well as defined disease management guidelines
  • Work with CPHO team, patient’s Primary Care Physician and all other providers of the patients’ care to develop individualized care plans
  • Facilitate communication with patients and care team, coordinate referrals, and promote optimal allocation of available resources
  • Measure progress toward goals based on clinical judgment, review of patients’ self-monitoring tools and trends in clinical data
  • Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions
  • Provide educational materials and resources to patient/family and their care providers
  • Refer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management.  
  • Analyze clinical data to track patient outcomes to determine improvement
  • Triage patient phone calls for acute patient issues and counsel accordingly
  • Oversight and management of population health quality improvement studies to reach established targets
  • Interface with Commercial and Government entities on care coordination, HEDIS and other QI activities
  • Report to UM/QM Committee on progress toward goals and make recommendations for improvement
  • Other duties as assigned
  • Minimum qualifications must be health plan requirements, including but not limited to licensure/certification, as applicable

What Humboldt Park Health employees say

Pay

Hours and flexibility

Workplace

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