Utilization Management Registered Nurse (RN) - Remote

📋 Description

• Performing timely reviews of healthcare services, including precertification and concurrent
• Accurately documenting clinical findings, criteria application, and determinations in accordance
• Communicating review determinations (written and/or verbal) to providers, members, and other
• Collaborating with the Medical Director and Peer Reviewer(s) on cases requiring further review.
• Interfacing routinely with ordering providers and provider organizations; communicate with members
• Integrating of Artificial Intelligence (AI) into daily workflow. Offer feedback and assist in

🎯 Requirements

• Registered Nurse with an active and unrestricted Illinois State License.
• Three years of experience in a variety of health care settings.
• Knowledge of utilization review, managed care, and community health.
• The State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year
• Computer skills including Microsoft 365 (Word, Excel, PowerPoint, etc).
• Strong organizational, writing, and speaking skills are necessary.

🎁 Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet