Utilization Mgmt Nurse Rev Cycle

Advocate Aurora Health; Oak Brook (IL); Remote; Full time

Job summary

A leading nonprofit health system is seeking a Utilization Management Registered Nurse to work full-time in a remote capacity. The ideal candidate will possess a Bachelor's Degree in Nursing and have over three years of experience in Utilization Review, alongside strong analytical and communication skills. This role demands fostering relationships and managing conflicts effectively while completing daily reviews for multiple facilities within the network.

Benefits

Comprehensive benefits and well-being programs

Competitive salary with potential incentives

Paid Time Off and retirement plans

Educational assistance

Qualifications

• 3+ years in clinical nursing with Utilization Review experience required.
• Familiar with Milliman Care Guidelines is a plus.
• Must achieve at least 80% on the IRR competency exam.

Responsibilities

• Complete 25-28 reviews daily for 9 hospitals.
• Interact with providers regarding care management.
• Analyze clinical scenarios using evidence-based criteria.

Skills

Critical thinking

Communication

Analytical skills

Flexibility

Interpersonal skills

Education

Bachelor's Degree in Nursing

Tools

Microsoft Office

Job description

Department: 11215 Advocate Aurora Health Corporate - Utilization Management

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Schedule Details/Additional Information:

• Position is remote.
• Full time - 80 hours a pay period.
• Monday - Friday, 8:30 AM - 5 PM. Every 5th weekend required. One summer and one winter holiday required.

Preferred Qualifications: Candidates with current Utilization Review or Care Management experience are strongly preferred.

Position Overview:

• Utilization Management Registered Nurse
• Ideal candidate will have a BSN and a background in Utilization Review.
• Responsible for completing 25-28 reviews daily for 9 Advocate Aurora hospitals.
• Strong communication skills required for interaction with providers.
• Familiarity with Milliman Care Guidelines is a plus.

Position Requirements:

• Level of Education: Bachelor's Degree in Nursing
• Experience: 3+ years in clinical nursing Utilization Review or quality management
• Proficiency in Microsoft Office (Excel, Outlook, PowerPoint, Word) or similar
• Knowledge of quality components and acute care patient needs related to care management
• Demonstrated knowledge and application of evidence-based Utilization Review criteria, achieving at least 80% on the IRR competency exam
• Critical thinking and analytical skills for clinical scenario analysis
• Excellent interpersonal and communication skills for collaboration with colleagues, physicians, and payers
• Ability to foster professional relationships and manage conflicts effectively
• Flexibility to adapt in a fast-paced, regulated healthcare environment and adhere to processes

Additional Schedule Details:

Position is remote with occasional in-office meetings in Oakbrook, Illinois.

Full time - 80 hours a pay period, Monday - Friday, 8:30 AM - 5 PM. Every 5th weekend and holiday work required.

Pay Range: $34.90 - $52.35

Our Commitment to You:

• Comprehensive benefits and well-being programs
• Competitive salary with potential incentives and increases
• Paid Time Off, health benefits, retirement plans, educational assistance, and more

About Advocate Health:

Advocate Health is a leading nonprofit health system in the U.S., serving nearly 6 million patients through a vast network of hospitals and care facilities. It is committed to clinical excellence, innovation, and community service.