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Utilization Reviewer Jobs in Bloomington, IL (NOW HIRING)

One to One Health

RN Case Manager

Normal, IL

$35 - $45/hr

Authorization & Utilization Review: Obtain necessary authorizations for treatment from insurance carriers. Provide clinical information to support the medical necessity of care and facilitate the ...

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CVS Health

Grad Pharmacist

Lincoln, IL · On-site

$16.25 - $20.25/hr

... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...

CVS Health

Grad Pharmacist

El Paso, IL · On-site

$16.50 - $20.50/hr

... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...

Arcadia Care

MDS Coordinator

Normal, IL · On-site

$35 - $43/hr

... plan reviews to assure completeness, thoroughness, and achievement of the optimal allowable Patient Driven Payment Model (PDPM) and Resource Utilization Group (RUG) categorization. Oversees the ...

Arcadia Care

MDS Consultant - Interim

Lincoln, IL · On-site

$85K/yr

... plan reviews to assure completeness, thoroughness, and achievement of the optimal allowable Patient Driven Payment Model (PDPM) and Resource Utilization Group (RUG) categorization. Oversees the ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Bloomington, IL

Utilization Reviewer information

See Bloomington, IL salary details

$29.7K

$36.4K

$42.2K

How much do utilization reviewer jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization reviewer in Bloomington, IL is $36,443.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,600.00 and $40,300.00 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.
More about Utilization Reviewer jobs

What job categories do people searching Utilization Reviewer jobs in Bloomington, IL look for?

The top searched job categories for Utilization Reviewer jobs in Bloomington, IL are:

What cities near Bloomington, IL are hiring for Utilization Reviewer jobs?

Cities near Bloomington, IL with the most Utilization Reviewer job openings:

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Bloomington, IL as of August 2026, with employment types broken down into 2% As Needed, 81% Full Time, 15% Part Time, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $36,443 per year, or $17.5 per hour.

Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm

Wexford Health Sources, Inc.

Lincoln, IL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 20 days ago

Wexford Health Sources rating

6.4

Company rating: 6.4 out of 10

Based on 30 frontline employees who took The Breakroom Quiz

648th of 898 rated healthcare providers

Job description

Medical Doctors Only Apply. A Family Practice Physician Traditional Practitioner practice is seeking a qualified physician for Lincoln, IL. This and other physician jobs brought to you by ExactMD. Wexford Health Sources, the nation's leading innovative correctional health care company, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality. For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services. At Wexford Health our philosophy is that health care should not be considered a luxury for anyone. We simply care for those in need and the corrections environment is our venue. Wexford Health has an exceptional opportunity for a Medical Director to join our team of healthcare professionals at the Logan Correctional Center, in Lincoln, IL. We’re proud to offer our providers an extremely competitive benefits package including: Company-paid medical malpractice insurance Generous company-paid CME allowance with paid time off to attend No completing insurance forms and waiting for reimbursement No hassles or overhead costs associated with private practice Steady income with no need to look for new patients Annual review with performance increase Generous paid-time off program that combines vacation and sick leave Paid holidays Comprehensive health insurance through Blue Cross Blue Shield Dental and Vision insurance 401(k) retirement saving plans Company-paid short-term disability Healthcare and dependent care spending account POSITION SUMMARY The Site Medical Director leads and oversees Wexford medical practice at their site(s) in order to ensure and promote high-quality medical care. They are ultimately responsible for all health care provided by Wexford Health Sources and delivered at their site(s). They are responsible for providing leadership in administrative matters, clinical program development, quality management, utilization management and staff education at their site(s) in a manner consistent with the corporate objectives and philosophy of Wexford Health Sources. DUTIES/RESPONSIBILITIES Responsibilities include, but are not limited to: Spends the majority of their time with direct patient contact and clinical care. Works closely with and maintains good relationships with the Regional Medical Director, the Director of Operations, the Regional Administrator, the site Health Care Unit Administrator and the state and county medical authority. Actively engaged in helping to identify and facilitate the solving of all operational and clinical issues for their site(s). Actively leads the evaluation and monitoring of chronic illness programs at their site(s). Actively participates in Facility Quality committees as requested. Actively leads all Utilization Management (UM) efforts at their site(s). Ensures that orientation and training of all medical and clinical staff is accomplished at their site(s). Other duties as required and/or assigned. The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.

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