Responsible for performing utilization review activities, the full-time Illinois Licensed Utilization Management RN will conduct timely healthcare service reviews, document clinical findings, and collaborate with providers and internal teams in a remote work environment. Key responsibilities Perform timely reviews of healthcare services, including precertification and concurrent reviews, using approved medical necessity criteria Document clinical findings and communicate review determinations to providers and members within established timeframes Collaborate with the Medical Director and Peer Reviewer(s) on cases requiring further review and assist in quality management activities Required qualifications Active and unrestricted Illinois State RN License Three years of experience in various healthcare settings Knowledge of utilization review, managed care, and community health Proficiency in Microsoft 365 applications Commitment to ongoing professional growth and education consistent with nursing practice standards
Illinois Licensed Utilization Management RN in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.