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Utilization Review Jobs in Wheaton, IL (NOW HIRING)

Mercy Medical Center

Medical Review Coordinator

Aurora, IL · On-site

$32 - $46.35/hr

Utilization Shift: Full-Time Facility : Mercy Medical Center Location : Aurora, IL Responsibilities Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case ...

Prime Healthcare

Medical Review Coordinator

Aurora, IL

$32 - $46.35/hr

Utilization Shift: Full-Time Facility : Mercy Medical Center Location : Aurora, IL Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and ...

Veracity

UR Review Case Manager (Admin)

Chicago, IL · On-site

The 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 provides ...

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 ...

UCAN

Quality Improvement Specialist II, III

Chicago, IL · On-site

Utilization Review * Contributes to the development of and assists in the maintenance of all quality standards, including service provision and documentation; works with service providers to assure ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Wheaton, IL

Utilization Review information

See Wheaton, IL salary details

$20

$40

$66

How much do utilization review jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review in Wheaton, IL is $40.87, according to ZipRecruiter salary data. Most workers in this role earn between $32.31 and $46.92 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

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.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

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 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, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Wheaton, IL? The most popular types of Utilization Review jobs in Wheaton, IL are:
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What job categories do people searching Utilization Review jobs in Wheaton, IL look for? The top searched job categories for Utilization Review jobs in Wheaton, IL are:
What cities near Wheaton, IL are hiring for Utilization Review jobs? Cities near Wheaton, IL with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Wheaton, IL as of August 2026, with employment types broken down into 6% Internship, 3% As Needed, 88% Full Time, and 3% Part Time. Highlights an 88% In-person, 9% Hybrid, and 3% Remote job distribution, with an average salary of $85,001 per year, or $40.9 per hour.

Utilization Review / Case Manager (RN)

Veracity

Chicago, IL • On-site

Other

Re-posted yesterday

Job description

Title: Utilization Review / Case Manager (RN)
Chicago, Illinois
Reports To: Clinical Director, Behavioral Health Services
Term: Permanent, Full-time
General Summary
The Utilization Review/Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner. The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.
Key Responsibilities
Utilization Management
  • Perform inpatient utilization management per plan, payer requirements, and standards.
  • Collaborate with physicians and healthcare team members for timely and appropriate patient management.
  • Collect and document clinical data to support admission and continued hospitalization.
  • Provide accurate clinical information to payers as required.
  • Support DRG Assurance Program with accurate data collection and assignment.
  • Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed.
Discharge Planning
  • Participate in family meetings and care conferences.
  • Ensure timely referrals for discharge planning and use of regional/community resources.
  • Refer complex cases to Social Services as appropriate.
  • Ensure psychological needs of patients are met via direct intervention or referral.
Communication & Coordination
  • Act as a central communicator with patients, families, vendors, payers, and hospital staff.
  • Provide continuity of care by leveraging community resources and maintaining updated resource manuals.
  • Refer cases not meeting criteria to Physician Advisor in a timely manner.
  • Follow up with Medical Director/Physician Advisor on unresolved issues.
Other Duties
  • Maintain safe patient care environment and infection control compliance.
  • Manage departmental operations (phones, supplies, data tracking).
  • Attend in-service presentations and complete all mandatory education.
  • Perform other duties as assigned.

Knowledge, Skills & Abilities
  • Graduate of an accredited school of nursing (Required)
  • Current RN License in Illinois (Required)
  • 2+ years relevant clinical experience (Preferred)
  • Utilization management experience (Preferred)
  • Knowledge of Medicare/Medicaid, Managed Care, and Commercial insurance processes (Preferred)
  • Strong written/oral communication skills with appropriate grammar and vocabulary
  • Proficiency in Microsoft Word and Excel (Required)
  • Ability to provide excellent customer service at all times
  • Ability to anticipate and coordinate multiple functions effectively

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