Illinois Licensed Utilization Management RN

Job Summary

To ensure cost-effective and appropriate healthcare services, the full-time Illinois Licensed Utilization Management RN will oversee patient admissions and care coordination, performing concurrent reviews and collaborating with healthcare professionals in a remote work environment.

Key responsibilities

• Manage patient admissions and status assessments based on medical necessity criteria
• Conduct concurrent reviews of patient charts to ensure proper resource utilization and identify practice trends
• Communicate with physicians regarding status changes and documentation, and assist in appeals for denied services

Required qualifications

• Licensed Registered Professional Nurse (RN) in Illinois
• Associate's Degree in Nursing or equivalent college diploma
• Experience in utilization management and acute care settings
• Strong data management skills, including proficiency in Word, Excel, Outlook, and EPIC Case Management software
• Knowledge of medical necessity criteria and healthcare reimbursement processes