Rising Medical Solutions is seeking a dedicated Utilization Review Nurse to join our healthcare team in Chicago, Illinois. This full-time position plays a critical role in ensuring that patients receive appropriate, high-quality care while managing healthcare resources effectively and maintaining compliance with regulatory standards. As a Utilization Review Nurse, you will conduct thorough reviews of medical records and treatment plans to determine medical necessity and appropriateness of care. You will collaborate with healthcare providers, insurance companies, and patients to facilitate optimal care coordination and cost-effective treatment decisions. Your expertise will help bridge the gap between clinical care and administrative requirements, ensuring that all stakeholders understand the rationale behind utilization decisions. Key responsibilities include performing prospective, concurrent, and retrospective utilization reviews using evidence-based criteria and clinical guidelines. You will analyze patient cases to identify opportunities for improved care coordination, document review findings accurately, and communicate decisions clearly to all parties involved. Additionally, you will participate in quality improvement initiatives and stay current with evolving healthcare regulations and best practices. The ideal candidate must possess an active Registered Nurse license in Illinois with a minimum of three years of clinical nursing experience, preferably in utilization review, case management, or managed care settings. Strong analytical and critical thinking skills are essential, along with excellent written and verbal communication abilities. Proficiency in electronic health records and utilization management software is highly desirable. Required qualifications include a Bachelor of Science in Nursing degree, current RN licensure, and certification in utilization review or case management is preferred. Candidates should demonstrate knowledge of healthcare regulations, insurance processes, and medical terminology. Previous experience with InterQual or Milliman criteria is advantageous. We offer competitive compensation, comprehensive health benefits, retirement planning options, and professional development opportunities. Employees enjoy a supportive work environment with opportunities for career advancement within the utilization management and case management fields. Rising Medical Solutions is committed to fostering a culture of continuous learning and professional growth. This role provides excellent opportunities for nurses looking to transition from direct patient care into a specialized healthcare administration position while maintaining their clinical expertise and making a meaningful impact on healthcare delivery and patient outcomes.