Utilization Review / Case Manager (RN) FT

Job Title: Utilization Review / Case Manager (RN)Location: Chicago, Illinois, USASetting: Acute Care Hospital – Case Management / Utilization ReviewJob Type: Full-timeCompensation: USD 80,000 – 95,000 (base salary)Job SummaryThe Utilization Review/Case Manager (RN) is responsible for facilitating the appropriate use of hospital resources and supporting safe, timely discharges. This role ensures that patients meet criteria for acute inpatient care, supports accurate DRG assignment, communicates with payers, and collaborates with social work and case management to coordinate discharge planning. The position serves as a central communicator with internal and external stakeholders and provides essential office and data management support for the department.Key ResponsibilitiesPerform inpatient utilization management activities in accordance with the hospital utilization plan, professional standards, and payer requirements.Work collaboratively with physicians, nursing, and the interdisciplinary team to ensure timely, appropriate patient management and level of care.Collect clinical data to support medical necessity for admission and continued stay; document clearly for payer review.Support the DRG Assurance Program through accurate data collection and completion of DRG worksheets, ensuring correct DRG assignment.​Provide accurate clinical information to payers and participate in concurrent and retrospective review processes.Identify and help resolve system issues that delay diagnostics, treatment, or discharge; collect data on avoidable days and profiling.Assist Patient Care Services in facilitating safe, timely discharges, including participation in family meetings and care conferences as needed.Ensure timely referrals for discharge planning and appropriate use of regional/community resources; refer complex cases to Social Services.Collaborate with clinical and social work experts to address psychosocial needs and ensure comprehensive patient services.​Interact regularly with physicians and the care team to discuss care progression, potential denials, and level of care concerns; refer non‑criteria cases to the Physician Advisor.Initiate and communicate termination of benefits or level of care changes in accordance with department procedures; follow up with Medical Director/Physician Advisor for resolution.​Serve as central communicator with internal and external customers, including patients, families, payers, vendors, and community agencies; demonstrate strong customer service skills.Maintain and update a resource manual for community and post‑acute services; support continuity of care across the continuum.Support efficient office operations including answering phones, ordering supplies, data entry, and tracking/compiling departmental data.​Actively seek ways to control costs while maintaining patient safety and quality of care.Participate in in‑services, mandatory education, and departmental meetings as required.​QualificationsGraduate of an accredited school of nursing required.Current, active RN license in the State of Illinois required.Minimum 2 years of relevant clinical nursing experience preferred.​Previous utilization management/utilization review and/or case management experience preferred.Knowledge of Medicare/Medicaid, managed care, and commercial insurance review processes preferred.Proficiency in Microsoft Word and Excel required.Strong written and verbal communication skills; excellent customer service orientation.Ability to proactively coordinate multiple functions and tasks in a dynamic office environment.BenefitsPaid sick time (effective 90 days after employment).Paid vacation time (effective 90 days after employment).Health, dental, and vision benefits (eligible at 30 days, beginning the 1st of the following month).Short‑ and long‑term disability and basic life insurance (after 30 days of employment).Additional InformationWork Location: In person (hospital setting).Equal opportunity employer; values diversity and inclusion.