Illinois Licensed Clinical Review Nurse

Job Summary

Performing concurrent reviews, the full-time Illinois Licensed Clinical Review Nurse will evaluate members' health, assess the appropriateness of care, and contribute to discharge planning in a remote setting, supporting the YouthCare program.

Key responsibilities:

• Conduct concurrent reviews to determine overall health and appropriate level of care for members
• Collaborate with Medical Affairs and healthcare providers to validate medical necessity and approve care determinations
• Document concurrent review findings and discharge plans in health management systems according to guidelines

Required qualifications:

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, with at least 2 years in acute care
• Current Illinois RN licensure
• Familiarity with Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred