RN Utilization & Clinical Denials Specialist

Carle Health; Champaign (IL); On-site; USD 50,000 - 80,000; Full time

Job summary

Carle Health is seeking a Registered Nurse for the Utilization Management team in Champaign, IL. The UM staff RN will ensure cost-effective, appropriate hospital care and coordinate admissions based on medical necessity criteria.

The role requires an Illinois RN license, nursing education, and strong communication with physicians and payers. Proficiency in EPIC Case Management and MS Office is highly valued, with a focus on resource utilization and care coordination.

Qualifications

• Licensed RN in Illinois (IDFPR).
• College Diploma in Nursing; Associate's Degree in Nursing.

Responsibilities

• Coordinate UM care to ensure cost-effective, appropriate use of health care services.
• Initial assessment of new patients for correct status (admission/observation/outpatient) based on UR medical necessity criteria.
• Perform concurrent reviews of patient charts to ensure proper resource utilization.
• Communicate with physicians on status changes and documentation.
• Educate physicians on resource utilization and participate in extended care reviews.
• Track Avoidable days and assist with appeals when necessary.

Skills

Interpersonal communication

Data management

Computer skills

Education

College Diploma: Nursing

Associate's Degree: Nursing

Tools

EPIC Case Management

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Carle Health is seeking a Registered Nurse for the Utilization Management team in Champaign, IL. The UM staff RN will ensure cost-effective, appropriate hospital care and coordinate admissions based on medical necessity criteria.

The role requires an Illinois RN license, nursing education, and strong communication with physicians and payers. Proficiency in EPIC Case Management and MS Office is highly valued, with a focus on resource utilization and care coordination.