8-Week Utilization Review RN ($50/hour) - IL RN License

We are seeking candidates for a contract role to cover for a Utilization Review RN on medical leave for 8 weeks . There is potential for extension or transition to contract-to-hire based on performance. This contract will be working at/supporting a Managed Care Organization (MCO)

Job Description:

• Target Start Date: Monday, July 22nd or Monday, July 29th
• Duration: 8-Week Contract (covering for someone on medical leave); possibility of extension or transition to contract-to-hire if meeting expectations.
• Location: First week requires training onsite in Park Ridge, IL (health plan). Afterward, the role transitions to fully remote for the remaining 7 weeks.

Position Details:

• 6 nurses on the team, managing 20-25 reviews daily.
• Queue management and various nursing services including observations, inpatient, home health, and aftercare.
• Case management involves contacting providers to gather clinic information within CMS-set timeframes, facilitating submissions via fax or phone.
• Utilizes Miliman guidelines and MHK protocols.

Must Have Skills/Qualifications:

• Active Illinois Registered Nurse (RN) license.
• Education: ADN or BSN.
• Experience in Utilization Review at a Managed Care Organization (MCO) preferred.
• Medicare utilization review experience.
• Milliman Care Guideline (MCG) experience.
• Ability to work/train onsite for the first week in Park Ridge, IL.

Soft Skill/Attribute Requirements:

• Professional communication with providers.
• Comfortable with technology.

Key Responsibilities:

• Conducts prospective, initial, concurrent, and retrospective reviews for various services including inpatient admissions, discharges, DME, Part B drugs, outpatient, and home health services.
• Monitors and ensures the quality of care provided and approved.
• Manages acutely and chronically ill patients to improve quality outcomes and reduce costs.
• Evaluates and provides feedback to treating physicians on discharge and home care plans, and available covered services.
• Ensures compliance with Utilization Management system turnaround times.
• Collaborates with Utilization Management Team Lead and Medical Director on care issues.
• Coordinates interdisciplinary approaches for continuity of care, including utilization management, transfer coordination, discharge planning, and authorization issuance.
• Identifies and assesses members for potential inclusion in comprehensive care coordination programs, referring as needed.

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