RN Utilization Specialist: Drive Right-Care Decisions

Northwestern Memorial Healthcare; Palos Heights (IL); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Tuition reimbursement

Loan forgiveness

401(k) matching

Lifecycle benefits

Job summary

Northwestern Medicine seeks an experienced RN Utilization Specialist to guide appropriate patient care decisions and ensure medical necessity documentation aligns with plans of care. You will collaborate with clinicians and payor teams to optimize utilization and discharge planning.

The role emphasizes performance improvement, education delivery, and data-driven reviews to sustain high-quality care within cost constraints.

Qualifications

• Licensed Registered Nurse in Illinois (IDFPR).
• Three years of experience in acute inpatient hospital care.
• Bachelor’s Degree in Nursing (preferred).

Responsibilities

• Applies medical necessity screening criteria to ensure appropriate admissions and LOS.
• Completes initial admission and continuing stay reviews for hospitalized patients.
• Collaborates with Payor Specialists and payors to communicate clinical information.
• Acts as liaison with clinical care team to assure compliance with contracts and guidelines.
• Participates in discharge planning rounds to facilitate communication on documentation and orders.
• Develops and presents education programs for service-lines and clinicians.

Skills

Analytical skills

Data interpretation

Team collaboration

Communication

Education

Bachelor’s Degree in Nursing

Tools

Word processing

Spreadsheets

Job description

Northwestern Medicine seeks an experienced RN Utilization Specialist to guide appropriate patient care decisions and ensure medical necessity documentation aligns with plans of care. You will collaborate with clinicians and payor teams to optimize utilization and discharge planning.

The role emphasizes performance improvement, education delivery, and data-driven reviews to sustain high-quality care within cost constraints.