- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... in Annapolis, MD + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the system, reporting to the Director of … more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- … utilization of resources and care coordination. Responsibilities The Utilization Management (UM) Consultant Registered Nurse (RN) demonstrates leadership, ... Summary The Hines VA Utilization Management (UM) RN reports to the UM...and can retrieve information from multiple sources/packages for case review (ie, CPRS, VistA, Outlook, NUMI, etc.) The UM… more
- Health Care Service Corporation (Chicago, IL)
- …decision making skills.** **PC and database experience.** **PREFERRED JOB REQUIREMENTS:** ** Utilization review experience.** **3 years clinical experience in ... Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) for medical… more
- Zurich NA (Schaumburg, IL)
- …medical terminology Preferred Qualifications: + 2 or more years' experience in Utilization Review , Case Management, Workers Compensation, or medical bill reviews ... Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL… more
- Rush University Medical Center (Chicago, IL)
- …on the circumstances of each case. **Summary:** The Bone Marrow Transplant (BMT) Oncology Nurse Navigator 2 is a registered nurse (RN) who works collaboratively ... with physician practices and multi-disciplinary teams as to promote the effective utilization of services and coordination of care for patients within the Section of… more
- Elevance Health (Chicago, IL)
- …4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... is granted as required by law. The **Medical Management Nurse ** is responsible for review of the...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer skills. For… more
- Rush University Medical Center (Chicago, IL)
- …may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care ... The CNL provides insight regarding the microsystem for collaboration with the Clinical Nurse Specialist (CNS) on macrosystem processes and outcomes. The CNL and CNS… more
- Fresenius Medical Center (Chicago, IL)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- CenterWell (Joliet, IL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Rush University Medical Center (Chicago, IL)
- …circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for ... information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure * National certification * Master's degree in Nursing from… more
- Prime Healthcare (Chicago, IL)
- …license. + Five (5) years of experience in acute hospital setting in a Utilization Review , Case Management, business office or related department. Experience in ... Set (MDS), and for tracking, and transmitting all data including the Resource Utilization Groups (RUGs) to the Department of Health and Human Services. The process… more
- Deloitte (Chicago, IL)
- …nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health ... in nursing, medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical Documentation Specialist - CCDS… more