Remote Utilization Review RN | Case Management & Compliance

Hinesassoc; Rockford (IL); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401k with match

Paid holidays

Remote work option

Life insurance

Job summary

Hines & Associates, Inc. seeks a Registered Nurse reviewer to assess patient conditions and certify treatments according to URAC and applicable regulations. The role emphasizes clinical judgment, documentation, and collaboration with case managers on active cases.

This is a Monday–Friday position, 9:30 AM to 6:00 PM CST, based in Illinois. You will support reviews, discharge planning, and adherence to standards while maintaining patient-centered care.

Qualifications

• Registered Nurse with an active, unrestricted license in the United States (state of employment).
• UR nurse orientation completed.
• Minimum of 3 years of recent acute clinical practice; 5 years preferred.
• Managed care, disability or workers' compensation experience is helpful but not mandatory.
• Strong customer service orientation and professional communication skills.

Responsibilities

• Complete first level reviews within scope of practice for clinical areas addressed.
• Assess patient status and certify medical, disability, and workers' compensation cases as appropriate.
• Understand criteria sets and determine when second level review is needed.
• Evaluate the appropriateness of current care plans and discharge needs.
• Maintain knowledge of URAC guidelines and company policies; ensure compliance.
• Perform onsite evaluations as needed and support additional responsibilities.

Skills

RN license

Customer service

Communication

Job description

Hines & Associates, Inc. seeks a Registered Nurse reviewer to assess patient conditions and certify treatments according to URAC and applicable regulations. The role emphasizes clinical judgment, documentation, and collaboration with case managers on active cases.

This is a Monday–Friday position, 9:30 AM to 6:00 PM CST, based in Illinois. You will support reviews, discharge planning, and adherence to standards while maintaining patient-centered care.