Illinois Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Registered Nurse.

Key Responsibilities

• Conduct timely reviews of healthcare services to support clinical determinations and document findings in compliance with regulations
• Collaborate with the Medical Director and providers for evaluations of medical necessity and treatment appropriateness
• Coordinate care and support members by identifying eligibility for disease management programs and managing on-call communications

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in Illinois
• 5+ years of experience in various healthcare settings
• Knowledge of utilization review and managed care processes
• Strong proficiency in Microsoft 365 applications
• Meets Illinois CE requirement of 20 hours per 2-year RN license renewal cycle