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Clinical Review Rn Jobs in Illinois (NOW HIRING)

AltaStaff

Care Review Clinician

Springfield, IL · On-site

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical ... Must have solid experience within a clinical setting as RN's must be able to use their knowledge to ...

AltaStaff

Care Review Clinician

Cherry Valley, IL · On-site

$40 - $42/hr

Care Review Clinician works with the Utilization Management team primarily responsible for medical ... Must have solid experience within a clinical setting as RN's must be able to use their knowledge to ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Collects information from clinical medical record for severity of illness and intensity of service ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

TNAA TotalMed RN

Travel Nurse RN - Psychiatric

Evanston, IL · On-site

$1.6K - $2.3K/wk

The Psychiatric Nurse also collaborates with clinical and case management staff to coordinate care ... TNAA TotalMed RN Job ID #1487754. Pay package is based on 8 hour shifts and 32.0 hours per week ...

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All JobsClinical Review Rn JobsClinical Review Rn Jobs in Illinois

Clinical Review Rn information

What is a clinical review RN?

Clinical Review RNs, or Clinical Review Registered Nurses, are licensed nurses who evaluate medical records, treatment plans, and health care documentation to ensure that patient care meets established standards and guidelines. They play a critical role in reviewing the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. Clinical Review RNs often work for insurance companies, hospitals, or healthcare organizations to help with utilization management, case review, and quality assurance. Their expertise helps improve patient outcomes and manage healthcare costs by ensuring the right care is delivered at the right time.

What skills and qualifications are needed to thrive as a clinical review RN?

To thrive as a Clinical Review RN, you need a robust clinical nursing background, strong assessment skills, and an active RN license, often with experience in case management or utilization review. Familiarity with utilization management software, electronic health records, and knowledge of insurance regulations or CMS guidelines is typically required. Excellent communication, critical thinking, and attention to detail help set outstanding Clinical Review RNs apart. These skills ensure accurate clinical evaluations, compliance with regulations, and effective coordination between patients, providers, and payers.

How does a clinical review RN collaborate with other healthcare professionals during the patient care review process?

A Clinical Review RN regularly works with physicians, case managers, social workers, and insurance representatives to assess the medical necessity and appropriateness of patient care plans. They participate in interdisciplinary meetings, provide clinical insights, and help ensure that care decisions align with policies and regulations. This collaboration is key to streamlining the review process, minimizing delays in patient care, and supporting optimal outcomes for both patients and the healthcare organization.

What is the difference between Clinical Review Rn vs Medical Reviewer?

AspectClinical Review RnMedical Reviewer
CredentialsRegistered Nurse (RN) license, clinical experienceMedical degree (MD or DO), specialized training
Work EnvironmentHealthcare facilities, insurance companies, telehealthHospitals, insurance companies, consulting firms
Employer & Industry UsageInsurance, healthcare providers, government agenciesInsurance, legal, healthcare consulting
Primary FocusAssessing medical records, determining coverage eligibilityEvaluating medical cases, providing expert opinions

While both roles involve reviewing medical information, Clinical Review Rns primarily assess insurance claims and medical records as registered nurses, whereas Medical Reviewers are typically physicians with advanced medical training who evaluate complex cases and provide expert opinions. Understanding these differences helps in choosing the right career path or job search focus.

How to become a clinical review RN?

To become a clinical review RN, you typically need to earn a Bachelor of Science in Nursing (BSN) or an associate degree in nursing, pass the NCLEX-RN exam to obtain licensure, and gain clinical experience in healthcare settings. Additional certifications in case management or utilization review can enhance qualifications for this role.

What does a clinical review RN do?

A clinical review RN evaluates medical records, treatment plans, and patient data to determine coverage, appropriateness, and compliance with healthcare policies. They often work for insurance companies or healthcare organizations, requiring strong clinical knowledge, attention to detail, and certification such as a registered nurse license. Their assessments help ensure proper patient care and cost-effective treatment decisions.
Clinical Review Rn jobs near you
Infographic showing various Clinical Review Rn job openings in Illinois as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Home Health Quality Assurance (QA) Nurse

Arlington Heights, IL • On-site

Center Of Illinois Home Healthcare
Health Care and Social Assistance • 51 - 200 employees
Learn more about Center Of Illinois Home Healthcareexternal

$60 - $80/hr

Other

Medical, PTO

Re-posted 21 days ago

Job description

Job Details

Job Location: Arligton Heights, IL 60005

Position Type: Full Time

Education Level: 2 Year Degree

Salary Range: $52,000.00 - $90,000.00 Salary/year

Job Shift: Monday-Friday

Home Health Quality Assurance (QA) Nurse

Center of Illinois Home Healthcare, Inc. is hiring an experienced Home Health Quality Assurance (QA) Nurse for our Medicare-certified, ACHC-accredited home health agency.

We are seeking a detail-oriented clinician with strong OASIS and Medicare knowledge to help ensure documentation accuracy, regulatory compliance, and timely processing of clinical records.

This position works closely with clinicians, intake, scheduling, coding, and leadership teams to maintain quality patient care and compliance standards.

Responsibilities
  • Review OASIS assessments for accuracy, completeness, and Medicare compliance
  • Review Plans of Care and clinical documentation for regulatory compliance
  • Ensure documentation meets CMS, ACHC, and agency standards
  • Communicate documentation corrections and education to field clinicians
  • Assist with timely OASIS submission and record processing
  • Collaborate with coders, clinical supervisors, and leadership teams
  • Monitor documentation timeliness and compliance metrics
  • Participate in quality assurance and performance improvement initiatives
  • Assist with audit preparation and compliance reviews
  • Support clinician education regarding documentation standards and best practices
Qualifications
  • Active Illinois RN / LPN license preferred
  • Minimum 2 years of Home Health experience required
  • Strong OASIS knowledge required
  • QA or clinical review experience preferred
  • Knowledge of Medicare Home Health regulations required
  • Experience with Axxess EMR preferred
  • Strong organizational and communication skills
  • Ability to manage multiple priorities and deadlines
Benefits
  • Competitive salary
  • Paid time off
  • Health benefits
  • Career growth opportunities
  • Supportive team environment
About Us

Center of Illinois Home Healthcare, Inc. is a Medicare-certified and ACHC-accredited home health agency providing skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aide services throughout Illinois.

Job Type
  • Full-time
Schedule
  • Monday to Friday
Experience
  • Home Health: 2 years required
  • OASIS: 1 year preferred
  • QA review: 1 year preferred
License/Certification
  • Illinois RN / LPN License preferred
Work Location
  • Arlington Heights, IL

*Salary is based on Licensure, Home Healthcare experience, Oasis knowledge, and Medicare regulatory experience*

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