Utilization Review Nurse - Flexible PTO & Growth

Rising Medical Solutions, LLC; Chicago (IL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Flexible time off

Health insurance

Dental insurance

Vision insurance

Profit sharing

401k matching

Career growth opportunities

Professional Development Reimbursement

Elevate program

Top Workplace 2023

Culture videos on YouTube

Facebook/LinkedIn presence

Job summary

Rising Medical Solutions in Chicago, IL is seeking a Utilization Review Nurse for a full-time position. You will perform UR processes, review records through various channels, and apply evidence-based guidelines to determine authorizations.

You will write nurse summaries and document decisions in our systems. The ideal candidate holds an RN license, a nursing degree, 3–5 years clinical or 2 years UR/case management, and strong analytical and communication skills.

Qualifications

• Associate's or Bachelor's degree in Nursing.
• Active RN license in one or more states.
• 3–5 years of clinical nursing practice or 2 years in case management or UR.
• Experience with Workers' Compensation, disability, or liability claims.
• Ability to work autonomously and in a team.
• Strong time-management and organizational skills.
• Proficient with CPT, ICD-9/ICD-10, and Medicare guidelines.
• Proficient with MS Word, Excel, and Outlook.

Responsibilities

• Perform all aspects of the Utilization Review process.
• Review UR requests via mail, email, fax, or phone.
• Apply evidence-based guidelines to authorize or refer files.
• Write nurse summaries for UR files.
• Document in Rising's databases and send determinations.
• Establish collaborative relationships with clients, patients, employers, providers and attorneys.
• Track ongoing status of UR activity to meet turnaround times.
• Maintain organized files with clinical documentation.
• Utilize good clinical judgment, listening, and critical thinking.
• Respond to inquiries regarding status of cases.
• Proficient use of multiple software programs.

Skills

Clinical experience

Communication

Analytical skills

Time management

Team collaboration

MS Word/Excel/Outlook

Education

Associate's or Bachelor's degree in Nursing

Tools

Microsoft Word

Excel

Outlook

Job description

Rising Medical Solutions in Chicago, IL is seeking a Utilization Review Nurse for a full-time position. You will perform UR processes, review records through various channels, and apply evidence-based guidelines to determine authorizations.

You will write nurse summaries and document decisions in our systems. The ideal candidate holds an RN license, a nursing degree, 3–5 years clinical or 2 years UR/case management, and strong analytical and communication skills.