Clinical Utilization Review Specialist

3 days ago


Rockford, Illinois, United States Hines and Associates Full time

**Company Overview:**

Hines and Associates is a nationwide, independent leader in personalized managed health care. We are committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

About Our Benefits:

  • We offer a competitive salary of $68,000 - $82,000 per year, based on experience.
  • A comprehensive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
  • A 401(k) plan with a company match, fully vested after 1 year.

Job Description:

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

Responsibilities:

  1. Complete first-level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review.
  2. Demonstrate ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention.
  3. Provide certification of medical, disability, and workers' compensation cases.

Requirements and Qualifications:

  • Licensed Practical Nurse with a 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:

  • No weekends and nights.
  • Paid holidays.
  • Work-life balance.
  • Remote/hybrid setting (once trained).


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

    Job OverviewHines & Associates Inc is a nationwide leader in personalized managed health care, focusing on comprehensive services with program excellence and cost containment. We are seeking a skilled Utilization Review Clinical Nurse Specialist to join our team.Compensation and BenefitsThe salary for this position is estimated at $85,000 - $110,000 per...


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

    About Us:Hines & Associates Inc. is a nationwide leader in personalized managed health care.We offer competitive salaries, benefits and a remote/hybrid work setting for our team members.Job Description:As a Clinical Utilization Review Specialist LPN, you will utilize your clinical knowledge and communication skills to obtain patient information and determine...


  • Rockford, Illinois, United States Hines and Associates Full time

    **Job Title:** Clinical Utilization Review SpecialistJob Description:This Clinical Utilization Review Specialist role involves utilizing clinical knowledge and communication skills to obtain patient-specific information regarding patient condition and proposed treatments and procedures.Responsibilities and Performance Metrics:Complete first-level reviews...


  • Rockford, Illinois, United States Hines and Associates Full time

    **About Us:** Hines and Associates is a nationwide, independent leader in personalized managed health care, focused on delivering exceptional services with unparalleled program excellence and cost containment. Our reputation as an industry leader is founded on over three decades of innovative and professional health care expertise. We serve all aspects of...


  • 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 UsHines & 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...


  • Rockford, Illinois, United States Hines and Associates Full time

    **About Hines and Associates:**We are a nationwide, independent leader in personalized managed health care, focused on what's important to you—comprehensive services with the program excellence and cost containment that you demand.Our Mission:To conserve health care dollars while ensuring quality care through effective programs and personalized service.Job...


  • Rockford, Illinois, United States Mercy Health System Full time

    About the RoleWe are seeking a highly skilled Hospital Coding Specialist to join our team at Mercy Health System. This role plays a crucial part in ensuring accurate and efficient coding practices, enabling us to provide high-quality patient care and achieve optimal reimbursement.Key ResponsibilitiesReview medical records meticulously to assign ICD-10 CM,...


  • Rockford, Illinois, United States OSF HR Team Full time

    About the RoleWe are seeking an Advanced Practice Provider to join our General Cardiology team as a 1.0 FTE Clinical Specialist.This role will involve working closely with three general cardiologists, primarily managing follow-up visits and occasionally conducting first consultations. The clinical specialist will work Monday through Friday in the clinic...

  • Clinical Specialist

    3 weeks ago


    Rockford, Illinois, United States Swedish American Full time

    OverviewSwedish American is seeking a highly skilled Clinical Specialist to join our team in the Neonatal Intensive Care Unit. As a key member of our healthcare team, you will provide critical care to newborns and infants requiring specialized medical attention.


  • Rockford, Illinois, United States ALOIS Healthcare Full time

    Travel OpportunityAward-winning ALOIS Healthcare is recruiting a dedicated Clinical Care Specialist in Respiratory Medicine to join their dynamic team in Rockford, Illinois. This challenging 13-week contract offers the chance to develop your skills and share your expertise with patients in need.About the RoleAs a Clinical Care Specialist, you will work...


  • Rockford, Illinois, United States Advantis Medical Full time

    Job Title: Radiation Therapist Clinical Specialist - Rockford, ILWe are seeking an experienced Radiation Therapist Clinical Specialist to join our team at Swedish American Hospital in Rockford, IL.About the Role:This 13-week contract position involves providing high-quality care to patients as a Radiation Therapist. The ideal candidate will have a passion...


  • Rockford, Illinois, United States Swedish American Full time

    Job DescriptionWe are seeking a highly skilled Clinical Respiratory Therapist Specialist to join our team at Swedish American.Key Responsibilities:Certification Requirements: IL RRT license is mandatory for this position. Additional Requirements: BLS/ACLS certification is required for RRT- Neonatal ICU staff members.Schedule: This role requires working...

  • Clinical Specialist

    2 weeks ago


    Rockford, Illinois, United States Grifols Full time

    Overview\Grifols is a global healthcare company that has been improving the health and well-being of people around the world since 1909. As a Clinical Specialist at Grifols, you will be part of an international team working to improve the future of healthcare.Salary: $3000 Sign On Bonus and competitive pay with opportunities for career growth and...


  • Rockford, Illinois, United States Anders Group Full time

    We are seeking a skilled Registered Respiratory Therapist to join our team as a Travel Respiratory Therapist - Clinical Specialist.This 13-week assignment is based in Rockford, Illinois and offers the opportunity to work with a reputable healthcare facility. The role requires a minimum of 36 hours per week, worked over 12-hour shifts.About the...


  • Rockford, Illinois, United States Travel Nurse Across America Full time

    Job SummaryWe are seeking a skilled Diagnostic Imaging Specialist to join our team in Rockford, Illinois. This is an exciting opportunity to work with cutting-edge technology and make a difference in the lives of patients.About the RoleThis full-time position involves working in a fast-paced environment, utilizing advanced diagnostic imaging equipment to...


  • Rockford, Illinois, United States Mercy Health Full time

    We are seeking a highly skilled Clinical Healthcare Specialist - Neurosurgery to join our team at Mercyhealth in Rockford, IL. Job Summary:This role will involve providing high-quality healthcare services to patients in the clinic and hospital setting under the supervision of neurosurgeons. The ideal candidate will have strong clinical skills, excellent...


  • Rockford, Illinois, United States Planet Healthcare Full time

    **About Planet Healthcare**At Planet Healthcare, we pride ourselves on taking a candidate-first approach to clinical staffing. Our consultative method helps us create the right opportunity at the right time for each healthcare professional.We understand the market demands and trends within your specialty, which is why our recruitment engine is driven by...


  • Rockford, Illinois, United States Rosecrance Inc. Full time

    About the RoleRosecrance Inc. is seeking a skilled Clinical Rehabilitation Specialist to join our team in Rockford, IL. This exciting opportunity offers a chance to make a meaningful impact in the lives of individuals and families struggling with substance abuse and mental health challenges.Job DescriptionWe are looking for a dedicated professional to...


  • Rockford, Illinois, United States Rockford Public School District #205 Full time

    School Nurse Position OverviewRockford Public School District #205 is seeking a highly skilled and dedicated Clinical Health Specialist - Pediatric Care to join our team. This exciting opportunity will allow the successful candidate to make a real difference in the lives of students, families, and staff members.About the Role:The Clinical Health Specialist -...


  • Rockford, Illinois, United States Mercy Health System Full time

    **Job Summary:**We are seeking a skilled Healthcare Coding Specialist to join our team at Mercy Health System. This is a full-time position that will be responsible for assigning accurate codes for diagnoses and procedures, as well as abstracting data elements needed for reimbursement and reporting purposes.About the Role:Review medical record documentation...