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Utilization Management and Review Services

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State & Local

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Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

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This subcontract for Utilization Management and Review Services supports prime contractors on State of Illinois Medical Programs projects. The scope of work involves performing clinical reviews of medical records using InterQual or MCG criteria and coordinating care management. To execute these duties, the provider must utilize licensed clinical professionals, such as Registered Nurses, Medical Doctors, or Licensed Clinical Social Workers, and maintain access to Electronic Health Record systems. Key deliverables include the production of utilization review reports, medical necessity determinations, and detailed utilization trend analysis. The services are performed in Springfield, Illinois, under NAICS code 621999. This opportunity was posted on October 31, 2025, for the agency's Medical Programs division.

General Info

Subcontract for clinical utilization management and medical record reviews for Illinois Medical Programs.

Agency

Illinois → Medical Programs

NAICS

621999 - All Other Miscellaneous Ambulatory Health Care Services

Place of Performance

Springfield, IL, 62704, USA

Set-Aside

NONE

Documents

This scope was carved out of 26-478HFS-MEDPR-B-49952.

The full solicitation package (1 document), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

26-478HFS-MEDPR-B-49952 | EMERGENCY NOTICE: Quality Improvement and Utilization Management

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Timeline

PostedOct 31

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Organization & Contact Information

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AgencyIllinois → Medical Programs

ContactsNo contacts available

OfficeN/A

Organization / AgencyIllinois → Medical Programs

Office AddressN/A

ContactsNo contact information available

Full Description

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Performs utilization review and management for prime contractors on State of Illinois Medical Programs projects. Conducts clinical review of medical records using InterQual or MCG criteria and coordinates care management. Requires licensed clinical professionals (RN, MD, LCSW) and access to Electronic Health Record (EHR) systems. Delivers utilization review reports, medical necessity determinations, and utilization trend analysis.

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