Care Review Clinician (RN) - (IL Nursing license)

Responsibilities: The clinician is responsible for performing utilization reviews to ensure services are medically necessary and align with clinical guidelines. They analyze service requests, determine prior authorizations, and collaborate with multidisciplinary teams to optimize member outcomes.

Requirements: Requires a Registered Nurse (RN) license active in Illinois and at least 2 years of experience in acute care, inpatient review, or managed care. Proficiency in MCG guidelines and utilization management is essential.

Key skills: Utilization Management, MCG Guidelines, Clinical Determinations, Prior Authorization, Medical Necessity Review, Case Management, Critical Thinking, Problem Solving, Microsoft Office

Keywords: RN, Utilization Management, MCG Guidelines, Prior Authorization, Managed Care, Clinical Review, Medical Necessity, CPHM, ICU, Emergency Room, Healthcare, Illinois Nursing License