Utilization Management Registered Nurse (RN) - Remote

📋 Description

• Perform timely precertification and concurrent reviews using medical necessity criteria.
• Document clinical findings, criteria, and determinations per standards.
• Communicate review determinations to providers, members, and others within timeframes.
• Collaborate with Medical Director and peers on complex cases.
• Interface with ordering providers; inform members when appropriate.
• Integrate AI into daily workflow and help improve AI tools.

🎯 Requirements

• RN with active Illinois license.
• Three years of healthcare experience.
• Knowledge of utilization review and managed care.
• CE: 20 hours per 2-year renewal.
• Microsoft 365 skills (Word, Excel, PowerPoint).
• Strong organizational, writing, and verbal skills.

🎁 Benefits

• Fully remote work environment.
• Medical, Dental, and Vision plans.
• 401(k) with 3% employer match to 6%.
• Life and Disability insurance; voluntary life options.
• Employee Assistance Program (EAP).
• Paid time off and paid parental leave.