Illinois Licensed Utilization Management RN

Job Summary

A company is looking for an RN - UM/Clinical Denial Management.

Key Responsibilities

• Oversee and manage functional and financial outcomes during patient hospitalization
• Perform concurrent reviews of patient charts to ensure proper resource utilization and compliance with medical necessity criteria
• Document utilization reviews and communicate with healthcare professionals regarding status changes and resource utilization

Required Qualifications

• Licensed Registered Professional Nurse (RN) in Illinois
• High School Diploma/GED and Associate's Degree
• Strong data management and computer skills, including proficiency in Word, Excel, Outlook, and EPIC Case Management software
• Ability to effectively communicate with physicians, payers, and hospital staff
• Expertise in acute level of care criteria and utilization management practices