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Utilization Jobs in Chicago, IL (NOW HIRING)

Insight

ED UTILIZATION REVIEW/CASE MANAGER

Chicago, IL

$85K - $90K/yr

The ED 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 ...

Insight

Transfer RN/UR

Chicago, IL

$70K/yr

Utilization Review Experience (Preferred) * Full time 11am-7 pm * Experience with Cerner (Preferred) * Excellent communication and organizational skills * Assesses, develops, facilitates, and ...

Insight

Transfer RN/UR

Chicago, IL · On-site

$70K/yr

Utilization Review Experience (Preferred) * Full time 11am-7 pm * Experience with Cerner (Preferred) * Excellent communication and organizational skills * Assesses, develops, facilitates, and ...

achn

UM RN Reviewer

Chicago, IL · On-site

Minimum 1-year Utilization Management experience preferred * Minimum 1-year Case management experience preferred * Experience with Epic System (EHR), InterQual a plus * Intermediate proficiency in ...

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 ...

New

UCAN

QI Coordinator

Chicago, IL

Coordinates utilization review process; including random selection of files; and scheduling. * Conducts utilizations reviews. * Provides feedback to agency programs regarding compliance with ...

New

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All JobsUtilization JobsUtilization Jobs in Chicago, IL

Utilization information

See Chicago, IL salary details

$22

$43

$71

How much do utilization jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization in Chicago, IL is $43.56, according to ZipRecruiter salary data. Most workers in this role earn between $34.42 and $50.00 per hour, depending on experience, location, and employer.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical coding and insurance policies. Relevant certifications such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. Strong analytical skills and attention to detail are essential for reviewing medical records and determining appropriate service utilization.

What is the difference between Utilization vs Resource Coordinator?

AspectUtilizationResource Coordinator
Primary FocusMeasuring and optimizing how staff time is usedManaging and assigning resources for projects
Required CredentialsOften no specific credentials, but industry experience helpsTypically requires organizational or project management skills
Work EnvironmentCorporate, healthcare, or consulting firmsProject teams, staffing agencies, or departments
Common UsageTracking staff utilization ratesAllocating resources to projects or tasks

Utilization focuses on measuring how effectively staff time is used, often to improve productivity. Resource Coordinator involves actively managing and assigning resources to ensure project needs are met. While related, utilization is more about analysis, and resource coordination is about execution and management.

What is a utilization specialist?

Utilization specialists are professionals who review and evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. They work closely with healthcare providers, insurance companies, and patients to ensure that care is delivered according to established guidelines and that resources are used effectively. Their goal is to help manage costs while ensuring patients receive the appropriate level of care.

What are some of the common challenges faced by utilization review specialists when assessing medical necessity of services?

Utilization Review Specialists often encounter the challenge of balancing patient advocacy with cost-effective care. They must stay updated on evolving insurance policies and clinical guidelines, which can be complex and change frequently. Additionally, coordinating with physicians and healthcare staff to obtain necessary documentation and clarifying treatment plans can be time-consuming. Strong communication skills and attention to detail are essential to ensure timely and accurate reviews, while also maintaining positive working relationships with clinical teams.

What are the key skills and qualifications needed to thrive as a utilization review specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN/LVN), strong analytical skills, and knowledge of insurance and medical necessity criteria. Familiarity with utilization management software, ICD-10/CPT coding, and regulatory guidelines like Medicare and Medicaid is typically required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These abilities are crucial to accurately evaluating patient care needs, ensuring regulatory compliance, and optimizing resource use within healthcare organizations.
Utilization jobs near you
Infographic showing various Utilization job openings in Chicago, IL as of August 2026, with employment types broken down into 3% As Needed, 83% Full Time, 11% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $90,598 per year, or $43.6 per hour.

ED UTILIZATION REVIEW/CASE MANAGER

Insight

Chicago, IL

$85K - $90K/yr

Full-time

Medical, Dental, Vision, Life, PTO

Re-posted 23 days ago

Job description

WE ARE INSIGHT
At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!
General Summary: The ED 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 assistance with discharge needs in a timely fashion.
This position is a central communicator with external and internal customers, including vendors, payers, community agencies, patients, families, hospital staff and departmental personnel. The position collaborates with social workers and case managers for discharge planning and utilization review activities. This individual supports the functions of the department with efficient office management of the department by answering phones, ordering supplies, typing/computer entry, tracking and compiling data.
Duties and Responsibilities:
  • Performs inpatient utilization management activities as determined by the utilization plan, professional standards and requirements of payers:
  • Works collaboratively with physicians and other healthcare team members to effect timely and appropriate patient management on an ongoing basis.
  • Collects data as required to support necessity of admission and continued hospitalization based on department standards.
  • Supports the DRG (Diagnosis Related Group) Assurance Program through data collection and ensures that the DRG worksheets contain complete and accurate information and appropriate DRG assignment.
  • Provides accurate clinical information to payers as required.
  • Resolves system problems impeding diagnostic or treatment progress such as delays in the discharge process.
  • Performs non-acute profiling, collecting data on avoidable days and physician advisor referral codes.
  • Assists in the division of Patient Care Services staff in facilitating the safe discharge of patients:
  • Participates in family meetings and care conferences as needed to resolve identified issues.
  • Ensures timely referrals for discharge planning occur and regional/community resources are utilized when available.
  • Refers complex cases to Social Services as indicated.
  • Uses clinical and social work experts as needed to ensure delivery of comprehensive patient services.
  • Ensures the patient’s psychological needs are met through direct intervention or consultation with appropriate discipline.
  • Interacts regularly with physicians and other members of the health team to obtain information about the course of care; provides information in return regarding potential denial of reimbursement or inappropriate level of care:
  • Refers cases not meeting criteria in a timely manner to the physician advisor.
  • Determines need for and carries out termination of benefits and level of care changes based upon department procedures and maintaining responsibility for related communication and follow-up.
  • Follows up with Medical Director/Physician Advisor to determine outcome or resolution.
  • Central communicator with external and internal customers:
  • Practices, develops and endorses customer services skills in relationships with internal and external customers.
  • Provide continuity of care by using community resources and maintains updated resource manual for the department
  • Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered.
  • Collaborates with multidisciplinary team in facilitating the care of the patients and families within the acute setting and along the healthcare continuum.
  • Attends in-service presentations and completes all mandatory education requirements.
Additional Duties and Responsibilities:
  • Maintains a safe patient care environment by identifying potential safety hazards and intervening appropriately.
  • Operates and maintains equipment used in patient care in a safe manner.
  • Understands and follows infection control requirements in the care of patients.
  • Maintains awareness of hospital changes by reading posted notices, attachments to paychecks and attending scheduled staff meetings.
  • Performs all other duties as assigned.

Knowledge, Skills, and Abilities:
  • Graduate of an accredited school of nursing required.
  • Current RN License in the State of Illinois required.
  • Two years of relevant clinical experience preferred.
  • Previous utilization management experience preferred.
  • Knowledge of Medicare/Medicaid, Managed Care and Commercial insurance review processes preferred.
  • Ability to proactively anticipate and coordinate multiple functions to promote an optimal office environment.
  • Communicates clearly in written and oral modalities with appropriate grammar and vocabulary.
  • Proficient in Microsoft Word and Excel required.
  • Ability to provide excellent customer service at all times.

Benefits:
  • Paid Sick Time - effective 90 days after employment
  • Paid Vacation Time - effective 90 days after employment
  • Health, vision amp; dental benefits - eligible at 30 days, following the 1st of the following month
  • Short and long-term disability and basic life insurance - after 30 days of employment

Insight is an equal opportunity employer and values workplace diversity!

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