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Urgent! Utilization Review / Case Manager (RN) Job Opening In Chicago Illinois – Now Hiring Veracity Software Inc

Utilization Review / Case Manager (RN)



Job description

Title: Utilization Review / Case Manager (RN)

Chicago, Illinois

Reports To: Clinical Director, Behavioral Health Services

Term: Permanent, Full-time


General Summary

The Utilization Review/Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner.

The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.



Key Responsibilities

Utilization Management


  • Perform inpatient utilization management per plan, payer requirements, and standards.

  • Collaborate with physicians and healthcare team members for timely and appropriate patient management.

  • Collect and document clinical data to support admission and continued hospitalization.

  • Provide accurate clinical information to payers as required.

  • Support DRG Assurance Program with accurate data collection and assignment.

  • Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed.


Discharge Planning


  • Participate in family meetings and care conferences.

  • Ensure timely referrals for discharge planning and use of regional/community resources.

  • Refer complex cases to Social Services as appropriate.

  • Ensure psychological needs of patients are met via direct intervention or referral.


Communication & Coordination


  • Act as a central communicator with patients, families, vendors, payers, and hospital staff.

  • Provide continuity of care by leveraging community resources and maintaining updated resource manuals.

  • Refer cases not meeting criteria to Physician Advisor in a timely manner.

  • Follow up with Medical Director/Physician Advisor on unresolved issues.


Other Duties


  • Maintain safe patient care environment and infection control compliance.

  • Manage departmental operations (phones, supplies, data tracking).

  • Attend in-service presentations and complete all mandatory education.

  • Perform other duties as assigned.





Knowledge, Skills & Abilities


  • Graduate of an accredited school of nursing (Required)

  • Current RN License in Illinois (Required)

  • 2+ years relevant clinical experience (Preferred)

  • Utilization management experience (Preferred)

  • Knowledge of Medicare/Medicaid, Managed Care, and Commercial insurance processes (Preferred)

  • Strong written/oral communication skills with appropriate grammar and vocabulary

  • Proficiency in Microsoft Word and Excel (Required)

  • Ability to provide excellent customer service at all times

  • Ability to anticipate and coordinate multiple functions effectively




Required Skill Profession

Other General



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    Unlock Your Utilization Review Potential: Insight & Career Growth Guide


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