Illinois Licensed Utilization Management RN
Job Summary
Responsible for performing utilization review activities, the full-time Illinois Licensed Utilization Management RN will conduct timely healthcare service reviews, document clinical findings, and collaborate with providers and internal teams in a remote work environment.
Key responsibilities
- Perform timely reviews of healthcare services, including precertification and concurrent reviews, using approved medical necessity criteria
- Document clinical findings and communicate review determinations to providers and members within established timeframes
- Collaborate with the Medical Director and Peer Reviewer(s) on cases requiring further review and assist in quality management activities
Required qualifications
- Active and unrestricted Illinois State RN License
- Three years of experience in various healthcare settings
- Knowledge of utilization review, managed care, and community health
- Proficiency in Microsoft 365 applications
- Commitment to ongoing professional growth and education consistent with nursing practice standards
Complete Job Description
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