Remote Nursing Jobs is seeking a dedicated and experienced Utilization Management Nurse to join our team in Illinois. In this remote role, you will be responsible for reviewing and evaluating the appropriateness of patient care services based on clinical criteria and guidelines. You will collaborate with healthcare providers, insurance companies, and patients to ensure optimal healthcare outcomes while managing costs. Your clinical expertise will be pivotal in assessing patient treatment plans, making recommendations for care adjustments, and ensuring compliance with regulatory standards. This position requires a strong understanding of healthcare regulations, insurance processes, and a commitment to improving patient care. By leveraging your nursing skills and knowledge, you will play a crucial role in enhancing the quality of care provided to patients while balancing the financial aspects of healthcare. If you are passionate about patient advocacy and possess strong analytical and communication skills, we encourage you to apply.

Key Responsibilities:

• Review and evaluate clinical information to determine the appropriateness of healthcare services.
• Conduct telephonic assessments and follow-ups with healthcare providers and patients.
• Collaborate with multidisciplinary teams to develop and implement patient-centered care plans.
• Ensure compliance with state and federal regulations, as well as insurance policies.
• Document and maintain accurate records of utilization management activities.
• Identify opportunities for improvement in patient care processes and outcomes.
• Provide education and support to patients regarding their treatment options and healthcare services.
• Stay updated on the latest healthcare trends, regulations, and best practices in utilization management.

Required Skills and Qualifications:

• Active Registered Nurse (RN) license in Illinois.
• Bachelor degree in Nursing (BSN) preferred.
• Proven experience in utilization management, case management, or a similar role.
• Strong understanding of healthcare regulations and insurance policies.
• Excellent analytical and problem-solving skills.
• Exceptional communication and interpersonal abilities.
• Proficient in electronic medical record (EMR) systems and Microsoft Office Suite.

Experience:

• Minimum of 3 years of nursing experience, with at least 1 year in utilization management or related fields.
• Experience working with diverse patient populations and understanding their unique needs.

Working Hours:

• This is a full-time remote position with flexible working hours, requiring availability during standard business hours (9 AM - 5 PM CST) with occasional after-hours support as needed.

Knowledge, Skills, and Abilities:

• Strong clinical assessment skills and critical thinking ability.
• Knowledge of care coordination processes and quality improvement initiatives.
• Ability to work independently and as part of a team.
• Strong organizational skills and attention to detail.

Benefits:

• Competitive salary with performance-based incentives.
• Comprehensive health, dental, and vision insurance.
• 401(k) retirement plan with company match.
• Generous paid time off (PTO) and holiday pay.
• Continuing education and professional development opportunities.
• Flexible remote work environment.

Why Join Us:

At Remote Nursing Jobs, we believe in fostering a supportive and collaborative work environment. We are committed to providing our team members with the resources and opportunities they need to excel in their careers. Joining our organization means becoming part of a team that values innovation, compassion, and excellence in patient care. If you are looking for a fulfilling career in healthcare that allows you to make a real difference, we invite you to apply.

How to Apply:

To apply for the Utilization Management Nurse position, please submit your resume and a cover letter detailing your relevant experience to us. We look forward to reviewing your application and potentially welcoming you to our team!