Illinois Licensed Utilization Review Specialist

Seeking a fully remote Illinois Licensed Utilization Review Specialist, the full-time position will manage clinical documentation reviews, ensure adherence to regulatory standards, and drive quality assurance processes while maintaining a consistent schedule from 8:00am to 4:30pm EST. Key responsibilities Evaluate clinical information and write/review various reports including Medical Record Reviews and Coding Reviews Perform quality assurance reviews of peer review reports to ensure compliance with company standards Develop and lead training sessions to promote high-quality utilization review practices Required qualifications Must hold and maintain a Registered Nursing License Strong knowledge of group health plans, clinical criteria sets, and change management Proficient in Microsoft Office Suite and general office equipment Strong understanding of medical terminology, anatomy, treatment protocols, and laboratory values Ability to work independently and manage time efficiently in a fast-paced environment