Onsite Utilization Review Nurse
Company: Rising Medical Solutions
Location: Chicago
Posted on: February 14, 2026
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Job Description:
Job Description Job Description As our Utilization Review Nurse,
you will coordinate and perform all aspects of Worker's
Compensation, auto, and general liability claims for medical
management activity (IME/Peer Review, UR) to ensure optimum medical
care service delivery, utilization of resources, and
cost-effectiveness. The UR Nurse will also provide professional
nursing expertise to the Medical Bill Review group as needed. Core
Responsibilities include: Perform all aspects of the Utilization
Review Process Review records and requests for UR, which may arrive
via mail, e-mail, fax, or phone Utilize evidence-based guidelines
to determine if authorization can be given versus having to send
the file for Peer or Physician Review Write nurse summaries on all
UR files Document properly in Rising's database (and client
databases when appropriate), and send determination letters on each
completed UR Establish collaborative relationships with clients,
patients, employers, providers, and attorneys Track the ongoing
status of all UR activity so that appropriate turn-around times are
met Maintain organized files containing clinical documentation of
interactions with all parties of every claim Utilize good clinical
judgment, careful listening, and critical thinking and assessment
skills Respond to various written and telephonic inquiries
regarding the status of the case Must be proficient in the use of a
computer, including the use of various software programs
simultaneously Print and mail all Massachusetts UR letters as
assigned Reports to: Director of MRU Requirements An Associate's or
bachelor’s degree in Nursing Hold an active RN/LPN license in
Illinois 3 to 5 years of clinical practice experience or 2 years of
case management and/or UR experience More than one state license (a
plus) You have your CCMC, CMAC, CRRN, CDMS or COHN (a plus)
Experience with Workers' Compensation, short-term or long-term
disability, or liability claims Bill review experience with
Workers' Compensation, Auto and/or Health Insurance carriers The
ability to set priorities and work both autonomously and as a team
member Well-developed time-management, organization, and
prioritization skills Excellent analytical skills Superb oral and
written communication The ability to gather data, compile
information and prepare summary reports Strong interpersonal and
conflict-resolution skills Experience in a fast-paced,
multi-faceted environment Demonstrated persistence and attention to
detail General understanding of CPT and ICD-9/ICD-10 codes and
Medicare guidelines Working knowledge of Microsoft Word, Excel, and
Outlook Ability to remain calm during stressful situations A
customer-service mindset Working Conditions: Position is located in
the Chicago Office Hours are 8:00 am to 4:00 pm Central Standard
Time (9:00 am to 5:00 pm Eastern Standard Time) Remaining in a
seated position Entering text or data into a computer Visual Acuity
Talking Hearing Repetitive arm, hand, and finger motion Benefits
Health insurance (6 different plans to choose from) Dental Vision
Paid time off (PTO) or Flexible Time Off (FTO) 401(k) Basic Life
Insurance and Long-Term Disability Insurance (paid by the company)
Voluntary Life Insurance and Short-Term Disability Insurance
Flexible Spending Accounts (FSA) Employee Assistance Program (EAP)
Rise Well Wellness Program Professional Development Reimbursement
Program (PDRP) You will be part of our new Elevate program designed
to recognize and reward employees for their hard work
Keywords: Rising Medical Solutions, DeKalb , Onsite Utilization Review Nurse, Healthcare , Chicago, Illinois
