RN Utilization Review & Care Coordination Specialist

Community First Medical Center; Chicago (IL); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental and vision insurance

Paid time off

Six paid holidays

Company paid life insurance

Short-term disability

401(k) after 90 days

Continuing Education reimbursement

Free Parking

Internal growth opportunities

Job summary

Community First Medical Center is seeking a Case Manager – Utilization Review RN to deliver clinically based case management and utilization review across the patient care continuum in Chicago, IL. You will collaborate with physicians, social workers, revenue cycle staff, and third-party payers to ensure appropriate utilization and safe patient transitions.

The role emphasizes discharge planning, medical necessity decisions, and ongoing care coordination with emphasis on regulatory compliance

Qualifications

• Associate Degree in Nursing is required.
• BSN degree is preferred.
• Minimum three (3) years of acute care nursing experience required.
• Minimum two (2) years of Case Management and/or Utilization Review experience preferred.
• Current Illinois Registered Nurse license required.
• ACM, CCM, or CMAC certification preferred.

Responsibilities

• Provide clinically based case management and utilization review services.
• Collaborate with physicians, interdisciplinary team, social workers, revenue cycle staff, and payers.
• Perform concurrent utilization review and medical necessity determinations.
• Assist with discharge planning and care coordination across continuum of care.

Skills

Analytical thinking

Critical thinking

Verbal communication

Written communication

Prioritization

Collaboration

Education

Associate Degree in Nursing

BSN preferred

Tools

EMR experience

InterQual criteria

MCG criteria

Job description

Community First Medical Center is seeking a Case Manager – Utilization Review RN to deliver clinically based case management and utilization review across the patient care continuum in Chicago, IL. You will collaborate with physicians, social workers, revenue cycle staff, and third-party payers to ensure appropriate utilization and safe patient transitions.

The role emphasizes discharge planning, medical necessity decisions, and ongoing care coordination with emphasis on regulatory compliance