Utilization Review Nurse: Drive Efficient, Quality Care

Advocate Health Care; Oak Brook (IL); On-site; USD 70,000 - 100,000; Full time

Job summary

Aurora Health Care in Illinois is seeking an experienced RN with utilization management expertise to support case review, clinical decision making, and payer communications. You will collaborate with physicians, hospital staff, and payers to ensure timely and compliant patient care.

The role requires knowledge of UM criteria, strong analytical and communication skills, and the ability to manage multiple cases while maintaining high quality documentation.

Qualifications

• RN license required.
• Bachelor's degree in Nursing or equivalent knowledge.
• Typically 3 years of clinical nursing, utilization and/or quality management experience.

Responsibilities

• Documents utilization review activity per department and medical center standards in a timely manner.
• Performs concurrent and retrospective reviews based on established criteria.
• Communicates with healthcare team and payers to expedite care and ensure compliance.
• Maintains knowledge of regulations, reimbursement issues, and regulatory requirements.
• Represents the organization positively to community networks and external partners.

Skills

Utilization Review

Nursing

Microsoft Office

Analytical skills

Communication

Conflict resolution

Team collaboration

Education

Bachelor's Degree in Nursing

Tools

None

Job description

Aurora Health Care in Illinois is seeking an experienced RN with utilization management expertise to support case review, clinical decision making, and payer communications. You will collaborate with physicians, hospital staff, and payers to ensure timely and compliant patient care.

The role requires knowledge of UM criteria, strong analytical and communication skills, and the ability to manage multiple cases while maintaining high quality documentation.