Illinois RN Utilization Review

Job Summary

Evaluating medical necessity and appropriateness of hospital admissions and surgical procedures, the full-time Illinois RN Utilization Review will ensure clinical information is provided to payors and authorizations are obtained, working primarily during day shifts in a remote capacity.

Key responsibilities

• Discusses criteria and payor decisions regarding hospital admissions and surgical procedures
• Documents outcomes in the electronic medical record and escalates denials for peer-to-peer consideration
• Performs reviews of pre-admission, perioperative, and postoperative surgical cases while collaborating with team members for process improvements

Required qualifications

• Graduate of an accredited school of nursing or equivalent education for licensing
• Two years of registered nurse experience
• Registered Professional Nurse (RN) license in Illinois