Illinois Licensed RN - Utilization Management

Job Summary

Providing concurrent and retrospective clinical review of inpatient medical records, the full-time Illinois Licensed RN - Utilization Management will evaluate acute care service utilization, facilitate appropriate documentation, and communicate with payers to ensure timely payment for services, working remotely during standard daytime hours.

Key responsibilities

• Conduct clinical case reviews utilizing Interqual criteria and document findings in electronic health records
• Communicate review findings and collaborate with Case Management, Social Services, and providers to support patient care continuity
• Manage relationships with third-party payers, ensuring timely submission of clinical information and follow-up on requests and denials

Required qualifications

• Licensed Registered Nurse (RN) in Illinois
• College Diploma in Nursing
• Experience in acute care settings
• Knowledge of Medicaid review processes and electronic health record systems
• Proficiency in Microsoft Office and effective communication skills