Utilization Management Registered Nurse (RN) - Remote

📋 Description

• Perform timely reviews of healthcare services, including precertification and concurrent reviews
• Accurately document clinical findings, criteria application, and determinations in accordance with
• Communicate review determinations (written and/or verbal) to providers, members, and other required
• Collaborate with Medical Director and Peer Reviewer(s) on cases requiring further review of medical
• Interface routinely with ordering providers and provider organizations; communicate with members or
• Integrate AI into daily workflow, provide feedback, and assist in teaching AI tools to improve

🎯 Requirements

• Active and unrestricted Illinois State Registered Nurse (RN) License.
• Three years of experience in a variety of health care settings.
• Knowledge of utilization review, managed care, and community health.
• Completion of 20 hours of CE per 2-year license renewal cycle as required by the State of Illinois.
• Computer skills including Microsoft 365 (Word, Excel, PowerPoint, etc).
• Strong organizational, writing, and speaking skills.

🎁 Benefits

• Comprehensive Medical, Dental, and Vision plans
• 401(k) plan with 3% employer match to 6% contribution
• Life and Disability insurance
• Voluntary Life options
• Employee Assistance Program (EAP)
• Paid time off plans