Care Review Clinician (RN) - (IL Nursing License)

JOB DESCRIPTION **Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 9:30 AM to 6:00 PM CST (30-minute lunch) or 9:00 AM - 6:00 PM CST (1 hour lunch) and requires prior experience in Utilization Management (UM) and the application of MCG guidelines. Candidates should be comfortable performing utilization reviews and making clinical determinations based on established criteria.** Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with...