Utilization Review Specialist - Impactful Care

Riverside Healthcare; Kankakee (IL); On-site; USD 56,000 - 76,000; Full time

Job summary

Riverside Healthcare in Kankakee, IL seeks a skilled Utilization Review Specialist to evaluate medical necessity, clinical appropriateness, and payer compliance. You will partner with physicians, nurses, and insurance teams to ensure optimal care utilization and accurate documentation.

The role requires an Associates degree (ADN or related) and RN licensing is highly desirable. You’ll engage in quality improvement, stay current with regulations and payer rules, and support revenue-cycle

Qualifications

• Associates degree in nursing or related field.
• Active RN license or relevant certification preferred.
• Experience in utilization review or case management is a plus.

Responsibilities

• Review patient cases for medical necessity and appropriateness.
• Communicate with physicians, nurses, and payers to secure authorizations.
• Maintain accurate utilization review records and reports.

Skills

2+ yrs clinical

Analytical skills

Communication skills

Education

ADN or related

RN license desirable

Tools

EHR systems

Utilization review software

InterQual/MCG

Job description

Riverside Healthcare in Kankakee, IL seeks a skilled Utilization Review Specialist to evaluate medical necessity, clinical appropriateness, and payer compliance. You will partner with physicians, nurses, and insurance teams to ensure optimal care utilization and accurate documentation.

The role requires an Associates degree (ADN or related) and RN licensing is highly desirable. You’ll engage in quality improvement, stay current with regulations and payer rules, and support revenue-cycle