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Key Responsibilities:
- Perform timely utilization review including precertification and concurrent reviews using approved medical necessity criteria.
- Collaborate with Medical Directors and Peer Reviewers on cases requiring medical necessity, treatment plans, or quality of care review.
- Integrate AI into daily workflow, providing feedback to improve reliability.
Qualifications:
- Active and unrestricted Illinois RN license and three years of healthcare experience.
- Knowledge of utilization review, managed care, and community health.
- Strong organizational, writing, and speaking skills, with excellent clinical judgment.
What We Offer:
- Comprehensive Medical, Dental, and Vision plans, plus a 401(k) with 3% employer match.
- Paid time off, parental leave, and life and disability insurance.
- Fully remote work environment with opportunities for professional growth.
Guidehealth
Guidehealth is a data-powered healthcare company that uses AI and predictive analytics to improve healthcare affordability and patient outcomes. It is a physician-led organization with a culture of accountability, learning, innovation, and empathy.