Strategic Utilization RN: Elevate Care

Northwestern Medicine; Palos Park (IL); On-site; USD 85,000 - 110,000; Full time

Job summary

Northwestern Medicine is seeking an RN Utilization Specialist in Illinois to support hospital utilization decisions and patient care planning. You will collaborate with clinicians, payors, and leadership to ensure appropriate level of care and medical necessity documentation.

The role emphasizes performance improvement, data monitoring, and adherence to regulatory standards while guiding clinical teams in utilization best practices. Strong communication and analytical skills are essential.

Qualifications

• Licensed Registered Nurse in Illinois (IDFPR)
• Three years of experience in acute inpatient hospital care
• Organizational, team building, coaching and conflict management skills
• Analytical skills to analyze data and solve problems
• Computer skills including word processing and spreadsheets

Responsibilities

• Applies utilization review criteria and level of care guidelines to ensure appropriate admissions and length of stay.
• Performs initial and continuing stay reviews for hospitalized patients.
• Collaborates with Payor Specialists and payors to communicate clinical information.
• Acts as a liaison with the care team to ensure compliance with contracts and guidelines.
• Identifies opportunities to improve utilization processes with leadership; monitors performance metrics.
• Participates in discharge planning rounds and supports education efforts for staff.
• Interacts with patients to educate on level of care and benefits.
• Assists in reporting financial indicators and quality improvement initiatives.

Skills

RN Illinois license

3+ years acute inpatient

Organizational skills

Team building

Coaching

Conflict management

Analytical skills

Data interpretation

Computer skills

Education

Bachelor’s Degree in Nursing

Job description

Northwestern Medicine is seeking an RN Utilization Specialist in Illinois to support hospital utilization decisions and patient care planning. You will collaborate with clinicians, payors, and leadership to ensure appropriate level of care and medical necessity documentation.

The role emphasizes performance improvement, data monitoring, and adherence to regulatory standards while guiding clinical teams in utilization best practices. Strong communication and analytical skills are essential.