Medical Utilization Review Professional

3 days ago


Rockford, Illinois, United States Hines & Associates Inc Full time

We are seeking a skilled Medical Utilization Review Professional to join our team at Hines & Associates Inc.

About Us

Hines & Associates Inc is a nationwide, independent leader in personalized managed health care. Our reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. We serve all aspects of the industry, committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

Job Summary

This role will involve utilizing clinical knowledge and communication skills to obtain patient-specific information regarding patient condition and proposed treatments and procedures. The successful candidate will determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement.

Responsibilities and Performance
  • Completes first-level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review.
  • Demonstrates ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention.
  • Evaluates appropriateness of current plan of care.
  • Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner.
Requirements
  • Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed.
  • Successful completion of UR nurse orientation program.
  • Minimum of 3 years recent acute clinical practice required, 5 years preferred.
What We Offer
  • Competitive salary: $85,000 - $105,000 per year.
  • Paid holidays and vacation time.
  • No nights, weekends, or holidays.
  • Remote/hybrid work setting (once trained).

Please note that the estimated salary range is based on national averages and may vary depending on location and experience. We offer a comprehensive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance. Additionally, we have a 401(k) plan with a company match, fully vested after 1 year.



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