Utilization Management Registered Nurse

Minimum Qualifications

Active, unrestricted Registered Nurse (RN) license in Illinois.

5+ years

of experience across varied healthcare settings.

Knowledge of utilization review, managed care processes, and community health.

Meets Illinois CE requirement of

All your information will be kept confidential according to EEO guidelines.

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

We are Driven by

A

ccountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.

We are seeking a

Clinical Care Manager

who is passionate about advancing high‑quality, compliant, patient‑centered care through precise and timely Utilization Review. In this role, you will apply clinical expertise and regulatory knowledge to evaluate healthcare services, ensure medically necessary care, support provider decision-making, and promote effective care coordination.

This is a detailed, analytical, and highly collaborative role that directly contributes to the integrity of care management operations and the member experience.

What You’ll Be Doing

Utilization Review & Clinical Determinations

WHO IS GUIDEHEALTH?

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.