{"schemaVersion":"jobsearcher.job.v1","id":"c8a2114feacd8ca556240ddb","url":"https://jobsearcher.com/jobs/c8a2114feacd8ca556240ddb","canonicalUrl":"https://jobsearcher.com/jobs/c8a2114feacd8ca556240ddb","title":"UTILIZATION REVIEW CASE MANAGER","description":"DESCRIPTION OF POSITION\nEnsures that quality clinical services and financial outcomes are achieved within established time frames for assigned patients. Coordinates the plan of care with the physicians, nurses and other health care professionals from admission through the discharge of the patient. Facilitates judicious use of hospital resources. Monitors physician clinical documentation for content and completeness to assure it accurately reflects and substantiates the patient's diagnosis and procedures. Performs admission, concurrent and retrospective reviews for medical necessity for hospitalization using evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure requirements and reviews relevant charts for compliance. Responsible for providing the clinical information required by insurance providers to ensure appropriate reimbursement for services provided to patients. Role includes accessing medical records to perform ongoing performance improvement audits.\nQUALIFICATIONS\n\nProfessional/Educational\nBachelor's degree required in a healthcare related field.\nCase management certification preferred (e.g. CCM, ACM, CPUM).\nMinimum of 3-5 years clinical experience in acute hospital setting.\nStrong clinical expertise.\nPrior experience in utilization management or case management preferred.\nAbility to maintain proficiency in the use of hospital information systems (i.e., McKesson, Microsoft Word/Excel, Meditech, Midas, etc.) to enter and access information and record data.\nGeneral knowledge of state and federal regulatory requirements and payer/reimbursement methodologies.\nLicensure as Registered Nurse in Illinois.\nDCFS Mandated Reporter Certificate of Completion required.\n\nPersonal\nAbility to communicate effectively in English, both verbally and in writing.\nExcellent negotiation skills with physicians and others to ensure patient receive appropriate and timely care.\nWork requires excellent interpersonal skills and the ability to maintain composure in difficult situations.\nAble to do manage multiple tasks in an organized manner; high degree of flexibility required.\nSelf -directed learner; enthusiastically seeks ways to improve patient care and motivate others to participate in improvement activities.\nPossesses leadership skills and knowledge of hospital operations.\nParticipates in training and orientation of new employees, as directed by manager.\nCommunicates effectively with physicians, patients and families, and all care providers.\nPossesses advanced conflict resolution skills.\nAbility to work independently and be self-directing.\nActual pay will be determined by qualifications, experience, and internal equity.\nMorris Hospital & Healthcare Centers offers a comprehensive benefit package including:\nMedical, dental, vision plans\nPaid time off\nRetirement plan, including immediate 100% vesting\nLife insurance\nDisability coverage\nNurse residency program\nWellness program\nHealth club / gym membership reimbursement\nReward & Recognition programs\nTuition Reimbursement\nEmployee Assistance Program\nhttps://www.morrishospital.org/careers/employee-benefits/#medical-dental-vision-and-flexible-spending-account\n\nLocation: Morris Hospital · MH CASE MANAGEMENT\nSchedule: FT, Days, 7:30am-4pm , 40 hours per week with an every 5th weekend rotation","company":"Morrishospital","rawCompany":"morrishospital","city":"Morris","state":"IL","isRemote":false,"isActive":false,"createdAt":"2026-07-27T13:54:30.560Z","occupations":[{"code":"21-1022.00","title":"Healthcare Social Workers","slug":"healthcare-social-workers"},{"code":"29-1141.00","title":"Registered Nurses","slug":"registered-nurses"},{"code":"11-9111.00","title":"Medical and Health Services Managers","slug":"medical-and-health-services-managers"}],"industries":[{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"622310","title":"Specialty (except Psychiatric and Substance Abuse) Hospitals","slug":"specialty-except-psychiatric-and-substance-abuse-hospitals"},{"code":"622210","title":"Psychiatric and Substance Abuse Hospitals","slug":"psychiatric-and-substance-abuse-hospitals"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"UTILIZATION REVIEW CASE MANAGER","description":"DESCRIPTION OF POSITION\nEnsures that quality clinical services and financial outcomes are achieved within established time frames for assigned patients. Coordinates the plan of care with the physicians, nurses and other health care professionals from admission through the discharge of the patient. Facilitates judicious use of hospital resources. Monitors physician clinical documentation for content and completeness to assure it accurately reflects and substantiates the patient's diagnosis and procedures. Performs admission, concurrent and retrospective reviews for medical necessity for hospitalization using evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure requirements and reviews relevant charts for compliance. Responsible for providing the clinical information required by insurance providers to ensure appropriate reimbursement for services provided to patients. Role includes accessing medical records to perform ongoing performance improvement audits.\nQUALIFICATIONS\n\nProfessional/Educational\nBachelor's degree required in a healthcare related field.\nCase management certification preferred (e.g. CCM, ACM, CPUM).\nMinimum of 3-5 years clinical experience in acute hospital setting.\nStrong clinical expertise.\nPrior experience in utilization management or case management preferred.\nAbility to maintain proficiency in the use of hospital information systems (i.e., McKesson, Microsoft Word/Excel, Meditech, Midas, etc.) to enter and access information and record data.\nGeneral knowledge of state and federal regulatory requirements and payer/reimbursement methodologies.\nLicensure as Registered Nurse in Illinois.\nDCFS Mandated Reporter Certificate of Completion required.\n\nPersonal\nAbility to communicate effectively in English, both verbally and in writing.\nExcellent negotiation skills with physicians and others to ensure patient receive appropriate and timely care.\nWork requires excellent interpersonal skills and the ability to maintain composure in difficult situations.\nAble to do manage multiple tasks in an organized manner; high degree of flexibility required.\nSelf -directed learner; enthusiastically seeks ways to improve patient care and motivate others to participate in improvement activities.\nPossesses leadership skills and knowledge of hospital operations.\nParticipates in training and orientation of new employees, as directed by manager.\nCommunicates effectively with physicians, patients and families, and all care providers.\nPossesses advanced conflict resolution skills.\nAbility to work independently and be self-directing.\nActual pay will be determined by qualifications, experience, and internal equity.\nMorris Hospital & Healthcare Centers offers a comprehensive benefit package including:\nMedical, dental, vision plans\nPaid time off\nRetirement plan, including immediate 100% vesting\nLife insurance\nDisability coverage\nNurse residency program\nWellness program\nHealth club / gym membership reimbursement\nReward & Recognition programs\nTuition Reimbursement\nEmployee Assistance Program\nhttps://www.morrishospital.org/careers/employee-benefits/#medical-dental-vision-and-flexible-spending-account\n\nLocation: Morris Hospital · MH CASE MANAGEMENT\nSchedule: FT, Days, 7:30am-4pm , 40 hours per week with an every 5th weekend rotation","datePosted":"2026-07-27T13:54:30.560Z","dateModified":"2026-07-27T13:54:30.560Z","hiringOrganization":{"@type":"Organization","name":"Morrishospital","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Morris","addressRegion":"IL","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"c8a2114feacd8ca556240ddb"},"url":"https://jobsearcher.com/jobs/c8a2114feacd8ca556240ddb"}}