RN Utilization Review Case Manager

About the role

This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.

Responsibilities

• Completing admission and concurrent chart reviews for medical necessity
• Working to prevent denials from all payers through timely review and documentation
• Managing and coordinating appeals for denied or at-risk accounts
• Collaborating with physicians, case managers, and interdisciplinary teams
• Making sure payer requirements and regulatory compliance standards are met
• Identifying denial trends and opportunities for process improvement
• Supporting efficient patient flow and appropriate level-of-care placement
• Ensuring accurate and timely documentation to support reimbursement

Requirements

• Graduate of an accredited School of Nursing (RN required)
• Current Illinois RN license
• Current BLS certification required
• Minimum 5 years of acute care clinical nursing experience required
• Experience in case management, discharge planning, utilization review, or appeals preferred
• Familiarity with InterQual and/or Milliman criteria preferred

Qualifications

• Strong critical thinking and clinical judgment skills
• Enjoy reviewing clinical documentation and problem-solving
• Detail-oriented and comfortable working with payer guidelines
• Thrives in a structured, policy-driven environment
• Wants to transition out of bedside nursing into a more administrative clinical role

Benefits

• Competitive pay: $32.00–$48.00/hr
• Comprehensive medical, dental, and vision insurance
• Paid vacation and holiday time
• Retail plan with employer match
• Stable weekday schedule (no nights or weekends)
• Supportive case management and interdisciplinary team environment
• Opportunity to directly impact quality metrics and hospital performance

Pay

Compensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.

Schedule

Stable weekday schedule (no nights or weekends)

Contact

Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time—while supporting quality, compliance, and patient outcomes. Apply today.