What are the responsibilities and job description for the Utilization Review Case Manager position at Hospital & Healthcare Medical Center?
Utilization Review Case Manager (Admin)
Location: Chicago, IL
Employment Type: Full-Time | Permanent
About the Role
We are seeking a detail-oriented and dedicated Utilization Review Case Manager (RN) to join our hospital-based care coordination team. The ideal candidate will ensure effective utilization of healthcare resources while facilitating smooth patient transitions and discharge planning.
This role requires collaboration with physicians, nurses, case managers, social workers, and insurance providers to ensure compliance with utilization management standards and optimal patient outcomes.
Key Responsibilities
- Review patient admissions and hospital stays to verify medical necessity and level of care.
- Collaborate with the healthcare team to promote appropriate patient management and timely discharges.
- Collect, document, and submit clinical data supporting hospital stays and medical necessity.
- Communicate with insurance payers for authorizations, continued stay reviews, and denials management.
- Participate in interdisciplinary care conferences and family meetings as needed.
- Identify barriers to discharge and coordinate with internal and external resources to address them.
- Refer complex cases to social services for additional support and follow-up.
- Maintain accurate and compliant documentation for utilization management and discharge planning.
- Contribute to cost containment initiatives without compromising patient safety or quality of care.
- Ensure adherence to hospital policies, confidentiality standards, and regulatory guidelines.
Qualifications
- Graduate of an accredited School of Nursing (RN) — required
- Active Illinois RN License — required
- Minimum 2 years of relevant clinical experience (acute care preferred)
- Prior experience in utilization review or case management — preferred
- Familiarity with Medicare, Medicaid, Managed Care, and Commercial insurance
- Proficiency in Microsoft Word, Excel, and EMR systems
- Excellent communication, problem-solving, and organizational skills
Compensation & Benefits
- Competitive salary based on experience
- Medical, Dental, and Vision Insurance
- 401(k) with Employer Match
- Paid Time Off and Sick Leave
- Short- and Long-Term Disability, Life Insurance
- Career advancement opportunities and continuing education support
Job Type: Full-time
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Vision insurance
Application Question(s):
- What are your salary expectations (hourly or annual base) for this position?
- What are your preferred hours or best time for a phone call?
- What is your work authorization/ Work Permit / Visa Status in the USA?
- Please share your regular email and regular phone number.
- Are you based nearby Chicago, Illinois; or are you willing to relocate to Chicago, Illinois for this position? Please share your location. (City, State & Zip code)
- Do you have a valid RN license in the State of Illinois? Or willing to obtain.
- Have you completed a nursing degree from an accredited school?
- How many years of clinical experience do you have?
- Do you have experience in utilization review, discharge planning, or case management? How many years?
Work Location: On the road
