Illinois Licensed Clinical Review Nurse
Job Summary
Supporting Illinois Medicaid and Ambetter utilization management, the full-time Illinois Licensed Clinical Review Nurse will perform concurrent reviews to evaluate member health, assess medical necessity, and contribute to discharge planning while working remotely from home.
Key responsibilities:
- Conducts concurrent reviews to determine the appropriateness of care and setting for members
- Collaborates with Medical Affairs and healthcare providers to discuss care delivery and approve medical determinations
- Documents review findings and maintains accurate member medical records in compliance with utilization management policies
Required qualifications:
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience, including 2+ years of acute care experience
- Current Illinois RN licensure is required
- Knowledge of Medicare and Medicaid regulations is preferred
- Familiarity with utilization management processes is preferred
Complete Job Description
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