Utilization Review Registered Nurse

Job not on LinkedIn

🕒 June 25

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $57.2k - $62.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 59%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

McPherson, Berry & Associates, Inc.

WebsiteLinkedInAll Job Openings

1 - 10 employees

💼 Consulting

🏥 Healthcare

🏭 Manufacturing

Consulting • Healthcare • Manufacturing

McPherson, Berry & Associates, Inc. is a company specializing in human resources services aimed at strengthening organizational capacity to deliver brand promises. They offer services in performance management, organizational and leadership development, coaching, online assessments, and diversity, equity, and inclusion initiatives. Their expertise also covers e-learning, recruiting, staffing, HR consulting, strategy development, and a range of management services. McPherson, Berry & Associates serve diverse industries including healthcare, manufacturing, federal/state/local government, and retail, offering tailored HR solutions that aim to improve and support business development and employee engagement.

📋 Description

• Obtain patient-specific information about conditions, treatments, and procedures • Determine whether illness or proposed services meet criteria sets and nursing practice guidelines for outpatient treatment or inpatient confinement • Certify treatment for confinement when criteria and guidelines are met • Defer decisions to a second-level reviewer when criteria are not met or are unclear • Interface with case managers and disease management nurses on active cases • Complete first-level reviews within the relevant clinical scope of practice • Assess patients’ current medical status, complications, and untoward events • Provide certification for medical, disability, and workers compensation cases • Evaluate the appropriateness of current plans of care • Assess aftercare needs and implement discharge planning or case management referrals • Maintain knowledge of advances and trends in medical care • Complete precertification and concurrent reviews according to applicable guidelines, regulations, and company procedures • Perform onsite evaluations as needed or requested • Communicate with hospital staff, physicians, providers, and Hines customer contacts • Document clinical information, patient status, benefit and claim concerns, and criteria validation • Communicate when higher-level review is required • Participate in self-evaluation and exchange constructive feedback • Perform additional responsibilities as assigned

🎯 Requirements

• Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed • For mental health/substance abuse reviews, licensed medical professional with an unrestricted license in the state or a state with licensure reciprocation with the office location • Accepted licensure includes RN, LMSW, or LMHC • Mental Health or Substance Abuse experience • Successful completion of UR nurse orientation program • Minimum of 3 years recent acute clinical practice required; 5 years preferred • Managed care, disability, or workers compensation experience helpful but not mandatory • Customer service orientation • Ability to sign and honor a confidentiality statement at hire and annually at performance reviews • Knowledge of URAC guidelines, Hines policies and procedures, standards of practice, disability and workers compensation regulations, and state and federal requirements • Ability to attain and maintain minimum quality assurance performance standards

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Long-term care • Short-term disability • Long-term disability • Company-paid and voluntary life insurance • Critical illness insurance • Accident insurance • Flexible spending • 401k plan with company match, fully vested after 1 year • No weekends and nights • Paid holidays • Work-life balance • Remote setting