Clinical Reviewer

5 days ago


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

Hines & Associates Inc. is a leading provider of personalized managed healthcare services, dedicated to delivering comprehensive solutions that meet the evolving needs of our clients.

Job Summary

We are seeking a highly skilled Clinical Reviewer - Utilization Review RN to join our team. As a Clinical Reviewer, you will play a critical role in ensuring the quality and appropriateness of healthcare services provided to our clients.

Key Responsibilities
  • Conduct thorough reviews of patient medical records to determine the necessity and appropriateness of healthcare services
  • Utilize clinical knowledge and expertise to make informed decisions regarding patient care
  • Communicate effectively with healthcare providers, patients, and family members to ensure seamless care coordination
  • Collaborate with internal stakeholders to develop and implement effective care management strategies
  • Stay up-to-date with industry developments, best practices, and regulatory requirements to ensure compliance and quality
Requirements
  • Registered Nurse with a valid, unrestricted 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
  • Managed care, disability, or workers' compensation experience helpful but not mandatory
  • Customer service-oriented
What We Offer
  • Competitive salary and benefits package
  • Opportunities for professional growth and development
  • Collaborative and dynamic work environment
  • Remote/hybrid work arrangement (once trained)


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