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Utilization Review Jobs in Geneva, IL (NOW HIRING)

Clarity Clinic

Utilization Review Clinician

Chicago, IL · On-site

$75 - $110/hr

The Utilization Review Clinician owns the clinical utilization review function for Clarity Clinic, covering prior authorization for admission, concurrent and continued stay review, peer to peer ...

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How much do utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review in Geneva, IL is $41.27, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.40 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 Geneva, IL?

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Geneva, IL as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $85,833 per year, or $41.3 per hour.

Utilization Review Clinician

Clarity Clinic, PLLC

Chicago, IL • On-site

$70 - $100/hr

Other

Posted 3 days ago

New

Job description

Utilization Review Clinician

Clarity Clinic, PLLC Chicago, Illinois, United States

About this position

About Clarity Clinic

Clarity Clinic is an interdisciplinary private practice bringing together Psychiatrists, Advanced Practice Providers (PAs, NPs), Psychologists, and Therapists. Our mission is to guide the whole person toward clarity and mental wellness through exceptional, holistic care. We offer a broad range of specialties and treatment approaches — including medication management, psychological assessment, and psychotherapy — to support people wherever they are in life. Through this multidisciplinary model, we're redefining what accessible, comprehensive mental health care looks like.

The Utilization Review Clinician owns the clinical utilization review function for Clarity Clinic, covering prior authorization for admission, concurrent and continued stay review, peer to peer review, and first level appeals across all higher level of care and specialty service lines. This is a licensed, non-treating clinical role. The incumbent applies clinical training to interpret the treatment record against payor medical necessity criteria and to represent Clarity Clinic's clinical case to payor reviewers.

This position is the primary clinical liaison with insurance payors during the pre-admission and active treatment phases. The Clinician ensures that authorizations are obtained and maintained in accordance with payor and regulatory requirements, and that documentation submitted to payors accurately reflects the treating clinician's record. The role operates against externally set payor deadlines, so it requires consistent responsiveness by phone and payor portal and flexibility to work additional hours when a determination deadline requires it.

Duties / Responsibilities:

Prior Authorization for Admission:

Review clinical documentation against payor medical necessity criteria before submission, identify gaps, and request the specific additions needed from the treating clinician. Prepare and submit prior authorization and precertification requests for admission to PHP, IOP, TMS, Esketamine, and neuropsychological testing. Track pending determinations, follow up daily until a decision is issued, and elevate delays that could affect admission timing. Document authorization numbers, approved dates and units, and payor contact information in AdvancedMD.

Concurrent Review and Continued Stay:

Conduct concurrent and continued stay review for all clients in an active higher level of care, submitting within payor required timeframes. Interpret progress notes, treatment plans, and assessments authored by the treating clinician to construct the medical necessity case for continued treatment. Monitor authorization expiration dates and initiate renewal review in advance to prevent lapses in authorized days. Communicate level of care changes, discharge planning needs, and authorization status to the treatment team, Intake, and Billing.

Peer to Peer and Appeals:

Conduct peer to peer review with payor medical reviewers where the payor accepts the incumbent's license level. Where a payor requires a prescriber or the treating provider, schedule the call and brief that clinician on the criteria at issue, the dates in question, and the supporting documentation. Prepare and submit first level appeals following an adverse determination, within the payor's appeal window. Log every adverse determination on the day it is received and notify the treatment team and Billing.

Compliance, Documentation, and Reporting:

Summarize and cite the treating clinician's record when communicating with payors. The Utilization Review Clinician does not author clinical findings, diagnoses, or assessments that the incumbent did not personally form, and does not alter the clinical record. Disclose only the

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