Illinois Licensed Utilization Management RN

Job Summary

Working remotely in a full-time capacity, the Illinois Licensed Utilization Management RN will oversee and manage the functional and financial outcomes of patient care during hospitalization, ensuring that services are medically necessary and cost-effective.

Key responsibilities

• Conduct initial assessments and concurrent reviews of patient charts to ensure appropriate resource utilization and compliance with medical necessity criteria
• Communicate with physicians regarding status changes, documentation, and resource utilization while tracking avoidable days and participating in extended care reviews
• Document utilization reviews in case management software and collaborate with appeal staff to address service denials

Required qualifications

• Licensed Registered Professional Nurse (RN) in Illinois
• Associate's Degree in Nursing or equivalent education
• Experience in utilization management or related healthcare settings
• Strong knowledge of acute level of care criteria and insurance documentation processes
• Proficiency in data management and relevant software, including EPIC Case Management