Illinois Licensed Utilization Review Specialist

Job Summary

A company is looking for a Utilization Review & Quality Assurance Specialist.

Key Responsibilities

• Evaluate clinical information and write/review various reports, ensuring compliance with standards
• Perform quality assurance reviews of peer reports and provide feedback to ensure clarity and professionalism
• Develop and lead training sessions to promote high-quality utilization review practices

Required Qualifications

• Must hold and maintain a Registered Nursing License or a related certification
• Experience in the insurance industry and/or utilization management is preferred
• Strong understanding of medical terminology, anatomy, and treatment protocols
• Proficient in Microsoft Office Suite and general office equipment
• Ability to work independently and manage time efficiently in a fast-paced environment