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Utilization Reviewer Jobs in Chicago, 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 ...

UHS

Utilization Management Coordinator

Chicago, IL

The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer ... Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all ...

UHS

Utilization Management Coordinator

Chicago, IL

The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer ... Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Chicago, IL

Utilization Reviewer information

See Chicago, IL salary details

$32K

$39.2K

$45.4K

How much do utilization reviewer jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization reviewer in Chicago, IL is $39,168.00, according to ZipRecruiter salary data. Most workers in this role earn between $35,100.00 and $43,300.00 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.
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Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Chicago, IL as of August 2026, with employment types broken down into 2% As Needed, 86% Full Time, 10% Part Time, and 2% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $39,138 per year, or $18.8 per hour.

Utilization Review Nurse

US Tech Solutions

Chicago, IL • On-site

Other

Re-posted 13 days ago

Job description

Chicago, IL

Contract

Job Description:

  • Participates in the development and ongoing implementation of QM Work Plan activities.

  • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives

Responsibilities:

  • Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.

  • Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.

  • Data gathering requires navigation through multiple system applications.

  • Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

  • Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.

  • Responsible for the review and evaluation of clinical information and documentation.

  • Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.

  • Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).

  • Independently coordinates the clinical resolution with internal/external clinician support as required.

  • Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data

  • Prepares and completes QM documents based on interpretation and application of business requirements

  • Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements

  • Assists in the development and implementation of QM projects and activities

  • Accountable for completing and implementation of QM Work Plan Activities

Experience:

  • 3+ years of experience as an RN

  • Registered Nurse in state of residence

  • Must have prior authorization utilization experience

  • Experience with Medcompass

Skills:

  • MUST HAVE MEDCOMPASS or ASSURECARE exp.

  • MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.

  • MUST HAVE UM experience, inpatient utilization management review.

  • MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.

  • MUST HAVE 6 months of Prior Authorization.

Education:

  • Active and unrestricted RN licensure in state of residence

Questionnaire:

  • Do you have experience with Medcompass?

  • Do you have experience with Prior Authorization?

  • Do you have experience with Utilization Review?

  • Do you have an Active Registered Nurse License?

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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