Rising Medical Solutions is currently seeking a qualified Utilization Review Nurse to join our healthcare team in Chicago, Illinois. This full-time position involves comprehensive evaluation of medical necessity and appropriateness of healthcare services to ensure quality patient care while effectively managing costs. The Utilization Review Nurse plays a critical role in reviewing clinical documentation, assessing treatment plans, and making evidence-based determinations regarding coverage and care coordination. Key Responsibilities include conducting thorough reviews of medical records and treatment requests to determine medical necessity according to established guidelines and criteria. The nurse will collaborate with healthcare providers, insurance companies, and case managers to facilitate appropriate care delivery while maintaining compliance with regulatory requirements. Additional duties involve preparing detailed reports, documenting review decisions, participating in appeals processes when necessary, and staying current with evolving healthcare regulations and clinical best practices. Required Qualifications for this position include an active Registered Nurse license in the state of Illinois, with a minimum of three years clinical nursing experience preferably in utilization review, case management, or managed care settings. Candidates must possess strong analytical and critical thinking skills along with excellent written and verbal communication abilities. Proficiency in electronic health record systems and medical review software is essential for success in this role. Skills necessary for this position encompass knowledge of medical terminology, understanding of healthcare reimbursement methodologies, familiarity with evidence-based clinical guidelines, and the ability to work independently while meeting productivity standards. The ideal candidate demonstrates attention to detail, strong organizational capabilities, and the capacity to handle sensitive medical information with confidentiality and professionalism. Company Info: Rising Medical Solutions is a leading healthcare services organization dedicated to improving patient outcomes through innovative medical management solutions. Our team of experienced professionals works collaboratively to deliver high-quality utilization review services that balance clinical excellence with cost-effective care delivery across various healthcare settings. Benefits offered with this position include competitive compensation packages, comprehensive health insurance coverage, retirement savings plans with employer contributions, paid time off, and professional development opportunities. Employees also enjoy a supportive work environment with access to ongoing training and career advancement pathways. Growth Opportunities: The Utilization Review Nurse position provides excellent potential for career advancement within the organization, including opportunities to progress into senior review roles, case management leadership positions, or specialized clinical review areas. Rising Medical Solutions supports continuous learning and professional development through educational assistance programs and certification support.