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Utilization Reviewer Jobs in Illinois (NOW HIRING)

UHS

Utilization Review Coordinator

Champaign, IL · On-site

$61K - $71K/yr

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

UHS

Utilization Review Coordinator

Champaign, IL

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

Ensure timely and accurate utilization review activities and payer communications. * Monitor patient progression, discharge planning, and continuity of care processes. * Collaborate with physicians ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

$37.55 - $56.33/hr

Ensure timely and accurate utilization review activities and payer communications. * Monitor patient progression, discharge planning, and continuity of care processes. * Collaborate with physicians ...

Summit BHC

Utilization Specialist

Champaign, IL

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Illinois

Utilization Reviewer information

See Illinois salary details

$30K

$36.8K

$42.6K

How much do utilization reviewer jobs pay per year?

As of Aug 21, 2026, the average yearly pay for utilization reviewer in Illinois is $36,815.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,900.00 and $40,700.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

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

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
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The top searched job categories for Utilization Reviewer jobs in Illinois are:

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Cities in Illinois with the most Utilization Reviewer job openings:

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

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Illinois as of August 2026, with employment types broken down into 2% As Needed, 89% Full Time, 7% Part Time, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $36,815 per year, or $17.7 per hour.

Utilization Reviewer-Full Time On-Site

Ben Gordon Center

Dekalb, IL • On-site

Full-time

Re-posted 5 days ago

Job description

Description

Required: Master's Degree in Social Work or Psychology or BSN with RN License.

Full-time, Monday through Friday

Standard 40-hour work week

Flexible start time between 7:00 AM and 8:30 AM

Utilization Reviewer - Behavioral Health Programs

Northwestern Medicine Ben Gordon Center
DeKalb, Illinois

Position Summary

The Utilization Reviewer for Behavioral Health Programs reflects the mission, vision, and values of Northwestern Medicine, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all applicable policies, procedures, regulatory standards, and accreditation requirements.

This position provides utilization review, documentation auditing, performance monitoring, and grant compliance support across a diverse portfolio of behavioral health programs. The Utilization Reviewer partners with leadership, clinical staff, quality teams, and grant managers to promote high-quality clinical documentation, regulatory compliance, financial sustainability, and achievement of program outcomes.

The role supports multiple behavioral health service lines, including but not limited to:

  • Crisis Continuum of Care Programs
    • Living Room Program
    • Mobile Crisis Response Team
    • Police Social Work Program
  • Outpatient Mental Health Services
  • Addiction Services
  • Community Support, Case Management, and Employment Programs
  • Grant-Funded Behavioral Health Initiatives and Programs
  • IM+CANS, IATP, and Treatment Plan Documentation Processes
  • Medicaid Rule 132 and Rule 2060 Programs
  • Certified Community Behavioral Health Clinic (CCBHC) initiatives

Responsibilities

Utilization Review & Documentation Compliance

  • Conduct concurrent, prospective, and retrospective utilization reviews of clinical records.
  • Review documentation for compliance with Medicaid, grant, accreditation, payer, and program-specific requirements.
  • Audit assessments, treatment plans, IM+CANS, IATPs, progress notes, discharge documentation, and other clinical records.
  • Monitor timeliness, completeness, and quality of documentation.
  • Identify trends in documentation deficiencies and recommend corrective actions.
  • Collaborate with clinical leaders to improve documentation quality and compliance outcomes.
  • Provide education, coaching, and technical assistance to staff regarding documentation standards and requirements.

IM+CANS & IATP Oversight

  • Monitor compliance with IM+CANS and IATP requirements across applicable programs.
  • Review clinical records to ensure assessments support treatment planning and medical necessity.
  • Evaluate documentation for consistency between assessment findings, diagnosis, treatment goals, interventions, and outcomes.
  • Assist with implementation of workflow improvements related to assessment and treatment planning processes.

Grant Compliance & Performance Monitoring

  • Support monitoring of state, federal, local, and private grant deliverables.
  • Track program performance measures, contractual outcomes, and quality indicators.
  • Assist leaders with collection, validation, and reporting of program performance data.
  • Participate in preparation for grant reviews, monitoring visits, audits, and fiscal administration reviews.
  • Collaborate with grant managers and program leaders to identify improvement opportunities when performance measures are not being achieved.

Quality Improvement & Analytics

  • Analyze utilization review findings and performance data to identify trends, risks, and opportunities.
  • Develop routine reports and dashboards for leadership review.
  • Participate in quality improvement initiatives and performance improvement projects.
  • Assist in the development and monitoring of corrective action plans.
  • Support organizational readiness for accreditation, state reviews, and regulatory audits.

Cross-Functional Collaboration

  • Work closely with clinical managers, directors, compliance staff, patient access teams, revenue cycle staff, grant managers, and analytics personnel.
  • Participate in interdisciplinary meetings focused on compliance, quality, grant performance, and clinical operations.
  • Serve as a resource regarding documentation standards, medical necessity, and service requirements.

Preferred Qualifications

  • Experience conducting utilization review, quality assurance, compliance monitoring, or chart auditing within a Community Mental Health Center (CMHC) or Certified Community Behavioral Health Clinic (CCBHC).
  • Experience with Illinois Medicaid Rule 132 and/or Rule 2060 programs.
  • Knowledge of behavioral health accreditation, regulatory, and payer requirements.
  • Experience with IM+CANS, IATP, treatment planning, and behavioral health documentation standards.
  • Experience supporting state and/or federal grant-funded behavioral health programs.
  • Experience tracking contractual deliverables, quality indicators, and performance measures.
  • Experience with EPIC or other behavioral health electronic health record systems.

Ideal Candidate

The ideal candidate is highly organized, detail-oriented, and passionate about improving quality across behavioral health services. They are comfortable working across multiple programs simultaneously and thrive in environments focused on compliance, performance improvement, data-driven decision-making, and exceptional patient care.

This individual understands that strong utilization review processes protect both patients and programs by ensuring services remain clinically appropriate, properly documented, fiscally sustainable, and aligned with grant and regulatory expectations.

Schedule & Work Environment

  • Full-time, Monday through Friday
  • Standard 40-hour work week
  • Flexible start time between 7:00 AM and 8:30 AM
  • Eight-hour shifts with consistent weekday scheduling
  • No routine weekend coverage required
  • Primarily office-based with regular collaboration across behavioral health, quality, compliance, grant, and operational teams
  • May participate in occasional meetings, trainings, audits, accreditation reviews, grant monitoring activities, and performance improvement initiatives
  • Hybrid work opportunities may be considered after successful completion of onboarding and demonstrated competency in core job functions, in accordance with departmental needs and Northwestern Medicine policies.

Qualifications

Required:

  • 2+ years of experience.
  • Master's Degree in Social Work or Psychology or BSN with RN License.

Preferred:

  • BSN with RN License. CERT BLS, CERT CADC, CERT CSADC, LIC CPC, LIC LCSW, LIC MSW, LIC RN.

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. 

Qualifications:

Required:

  • 2+ years of experience.
  • Master's Degree in Social Work or Psychology or BSN with RN License.

Preferred:

  • BSN with RN License. CERT BLS, CERT CADC, CERT CSADC, LIC CPC, LIC LCSW, LIC MSW, LIC RN.
Education:Not in Patient Care Giver RoleEmployment Type: Full-time

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