Illinois Licensed RN Manager

Job Summary

Leading a dedicated team in a fully remote capacity, the Illinois Licensed RN Manager will oversee Utilization Management activities, ensuring high-quality patient care, compliance with regulations, and effective care coordination while working standard day shifts with occasional weekend support.

Key responsibilities

• Oversee department operations, including referrals and medical necessity reviews, ensuring adherence to policies and regulatory standards
• Monitor team performance metrics and adjust staffing patterns to maintain adequate coverage for Utilization Management operations
• Lead the development and implementation of Utilization Management programs and processes, fostering a culture of accountability and collaboration

Required qualifications

• Bachelor's degree in nursing
• Two years of acute nursing experience and five years of utilization management experience, including two years in a leadership role
• Extensive knowledge of CMS, Medicare & Medicaid, and Commercial regulations
• Experience managing large cross-functional teams and leading denials and appeals resolutions
• Current Registered Professional Nurse (RN) license in Illinois