More jobs:
Utilization Management Nurse
Job in
Elgin, Kane County, Illinois, 60122, USA
Listed on 2026-09-16
Listing for:
Jobtailor
Full Time
position Listed on 2026-09-16
Job specializations:
-
Nursing
RN Nurse, Healthcare Nursing
Job Description & How to Apply Below
- Review and authorize Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS)
- Evaluate member needs using clinical expertise and evidence-based criteria
- Interpret criteria, policies, and procedures related to LTSS authorizations
- Make coverage determinations and decisions related to denials for HCBS-covered services
- Coordinate and communicate with providers, members, and interdisciplinary teams
- Create timely and accurate authorizations and determinations
- Ensure compliance with Illinois HFS, contractual, and regulatory requirements
- Facilitate optimal care, treatment, and service delivery
- Support Illinois Medicaid members and providers
- Licensed Registered Nurse (RN) in Illinois with no disciplinary action
- 1+ years of experience in utilization management/LTSS service authorization
- 2+ years of clinical experience
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel
- Must reside in Illinois
- Minimum internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information
- Preferred:
Bachelor's degree in nursing, Health Services, Healthcare Administration, Business Administration, or a related field - Preferred:
Previous Medicare/Medicaid experience - Preferred:
Experience in discharge planning and/or home health, HCBS, rehabilitation, or LTSS programs
Demonstrates expertise in Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) authorizations, with a strong focus on compliance with Illinois HFS regulations and effective communication with interdisciplinary teams. Proficient in clinical evaluation and decision-making to facilitate optimal care for Illinois Medicaid members.
Highest-signal resume keywords- Licensed Registered Nurse (RN)
- Utilization Management
- Clinical Experience
- Microsoft Office Suite
- Medicare/Medicaid Experience
- LTSS Authorization
- HCBS Coverage Determination
- Clinical Evaluation
- Evidence-Based Criteria Interpretation
- Compliance with Regulatory Requirements
- Communication
- Coordination
- Interpersonal Skills
- Registered Nurse (RN) License in Illinois
- Illinois HFS
- Medicaid
- Home Health
- Discharge Planning
- Rehabilitation
- Microsoft Word
- Microsoft Outlook
- Microsoft Excel
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