Illinois Licensed Utilization Management RN

Job Summary

To support healthcare operations, the full-time Illinois Licensed Utilization Management RN will perform utilization review activities remotely, ensuring compliance with regulations and accurately documenting clinical information while collaborating with providers and internal teams.

Key responsibilities

• Perform timely reviews of healthcare services, including precertification and concurrent reviews, using established medical necessity criteria
• Collaborate with medical directors and peer reviewers on cases requiring further review and communicate determinations to relevant parties
• Initiate referrals to disease management programs and participate in quality management activities to support continuity of care

Required qualifications

• Active and unrestricted Illinois State License as a Registered Nurse
• Three years of experience in various healthcare settings
• Knowledge of utilization review, managed care, and community health
• Proficient in Microsoft 365 applications
• Completion of 20 hours of continuing education per 2-year license renewal cycle as required by the State of Illinois