Illinois Licensed Utilization Management RN

Job Summary

Serving as the system-wide point of coordination, the full-time Illinois Licensed Utilization Management RN will manage Utilization Management initiatives, perform audits on denial accounts, and collaborate with Managed Care Organization teams, all while working remotely during day shifts.

Key responsibilities

• Act as a direct resource for regional physician liaisons on Utilization Management issues and initiatives
• Conduct audits on UM denial write-off accounts to identify root causes and opportunities for claims re-bill
• Serve as a subject matter expert on state and federal regulatory requirements related to Utilization Management processes

Required qualifications

• Graduate of an accredited school of nursing or equivalent education for licensing
• Two years of acute nursing experience and four years of Utilization Management experience
• Current Registered Professional Nurse (RN) license issued by the Illinois Department of Financial and Professional Regulation