Job Description
📋 Description Perform timely precertification and concurrent reviews using medical necessity criteria. Document clinical findings, criteria, and determinations per standards. Communicate review determinations to providers, members, and others within timeframes. Collaborate with Medical Director and peers on complex cases. Interface with ordering providers; inform members when appropriate. Integrate AI into daily workflow and help improve AI tools. 🎯 Requirements RN with active Illinois license. Three years of healthcare experience. Knowledge of utilization review and managed care. CE: 20 hours per 2-year renewal. Microsoft 365 skills (Word, Excel, PowerPoint). Strong organizational, writing, and verbal skills. 🎁 Benefits Fully remote work environment. Medical, Dental, and Vision plans. 401(k) with 3% employer match to 6%. Life and Disability insurance; voluntary life options. Employee Assistance Program (EAP). Paid time off and paid parental leave.
