Illinois Licensed Utilization Review RN

Job Summary

Evaluating the medical necessity of hospital admissions and surgical procedures, the full-time Illinois Licensed Utilization Review RN will manage communication with payors, document outcomes in electronic medical records, and participate in team improvement initiatives while working remotely.

Key responsibilities

• Discusses criteria and decisions with payors and escalates denials for peer-to-peer consideration
• Documents outcomes in electronic medical records and performs reviews of surgical cases
• Applies evidence-based practices to nursing care and participates in utilization management tasks as assigned

Required qualifications

• Graduate of an accredited school of nursing or equivalent education for licensing
• Two years of registered nurse experience
• Current Registered Professional Nurse (RN) license in Illinois
• Prior Utilization Review experience preferred
• Compact license or licensure in multiple states preferred