Illinois Licensed Care Review Clinician

Job Summary

Offering a fully remote opportunity, the Illinois Licensed Care Review Clinician will assess clinical service requests, ensure compliance with guidelines, and verify the medical necessity of services while working full-time from 8:30 AM to 5:30 PM CST.

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews to determine prior authorization and collaborate with multidisciplinary teams

Required qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in Illinois
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite and applicable software programs