Performing medical record reviews and liaising with external review agencies, the full-time Illinois Licensed Utilization Review Nurse will ensure compliance with regulations affecting financial reimbursement while primarily working remotely with occasional onsite requirements for orientation and training. Key responsibilities Collects and documents information from clinical medical records regarding severity of illness and intensity of service Monitors levels of care for appropriateness and communicates variances while evaluating care plans against accepted standards Provides information to external review organizations and refers patients not meeting criteria to designated physician advisors Required qualifications Current Registered Nurse (RN) licensure BSN preferred, with 2-5 years of previous Utilization Review experience Current CPR certification Experience in hospital nursing, hospital case management, insurance case management, or utilization management preferred Knowledge of clinical norms and standards