reputed company Review Specialist RN (Utilization Management/ Appeals)
Job Title: reputed company Review Specialist
Location: Chicago, IL
Contract duration: 7 months
Schedule: reputed company to 5pm (M-F)
Key Responsibilities:
• Manage and resolve member and provider appeals.
• Ensure compliance with NCQA, URAC, DOI, and regulatory guidelines.
• Collaborate with Medical Management, FSU, and reputed company teams.
• Support audits, reporting, and reputed company initiatives.
• Communicate directly with members, providers, and internal teams.
Requirements:
• Registered reputed company (RN) with Bachelor’s degree.
• 5+ years of experience in utilization management, appeals, or claims.
• Strong knowledge of managed care and accreditation standards (NCQA/URAC).
• Excellent communication, organizational, and MS Office skills.
Preferred:
• RN with Appeals and/or Utilization Management experience.
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