Illinois Licensed Utilization Management RN

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