Illinois Licensed Utilization Review Specialist

Job Summary

Seeking a fully remote Illinois Licensed Utilization Review Specialist, the full-time position will manage clinical documentation reviews, ensure adherence to regulatory standards, and drive quality assurance processes while maintaining a consistent schedule from 8:00am to 4:30pm EST.

Key responsibilities

• Evaluate clinical information and write/review various reports including Medical Record Reviews and Coding Reviews
• Perform quality assurance reviews of peer review reports to ensure compliance with company standards
• Develop and lead training sessions to promote high-quality utilization review practices

Required qualifications

• Must hold and maintain a Registered Nursing License
• Strong knowledge of group health plans, clinical criteria sets, and change management
• Proficient in Microsoft Office Suite and general office equipment
• Strong understanding of medical terminology, anatomy, treatment protocols, and laboratory values
• Ability to work independently and manage time efficiently in a fast-paced environment