Illinois Licensed Utilization Review Nurse

Job Summary

Performing medical record reviews and liaising with external review agencies, the full-time Illinois Licensed Utilization Review Nurse will ensure compliance with regulations affecting financial reimbursement while primarily working remotely with occasional onsite requirements for orientation and training.

Key responsibilities

• Collects and documents information from clinical medical records regarding severity of illness and intensity of service
• Monitors levels of care for appropriateness and communicates variances while evaluating care plans against accepted standards
• Provides information to external review organizations and refers patients not meeting criteria to designated physician advisors

Required qualifications

• Current Registered Nurse (RN) licensure
• BSN preferred, with 2-5 years of previous Utilization Review experience
• Current CPR certification
• Experience in hospital nursing, hospital case management, insurance case management, or utilization management preferred
• Knowledge of clinical norms and standards