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Illinois Licensed Utilization Review RN
Evaluating the medical necessity of hospital admissions and surgical procedures, the full-time Illinois Licensed Utilization Review RN will manage communication with payors, document outcomes in electronic medical records, and participate in team improvement initiatives while working remotely. Key responsibilities Discusses criteria and decisions with payors and escalates denials for peer-to-peer consideration Documents outcomes in electronic medical records and performs reviews of surgical cases Applies evidence-based practices to nursing care and participates in utilization management tasks as assigned Required qualifications Graduate of an accredited school of nursing or equivalent education for licensing Two years of registered nurse experience Current Registered Professional Nurse (RN) license in Illinois Prior Utilization Review experience preferred Compact license or licensure in multiple states preferred
