- US Tech Solutions (Chicago, IL)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech… more
- AdventHealth (La Grange, IL)
- …skills **.** Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** **.** State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… 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
- Fresenius Medical Center (Chicago, IL)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- CVS Health (Chicago, IL)
- …we do it all with heart, each and every day. **Position Summary** The RN Case Manager is responsible for coordinating all case management activities with members to ... through integration. + Through the use of clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an approach… more
- Molina Healthcare (Chicago, IL)
- REGISTERED NURSE must be licensed for the state of Illinois and must be willing to work CENTRAL daytime business hours 9AM to 6PM.** **JOB DESCRIPTION** **Job ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- CenterWell (Chicago, 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...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Rush University Medical Center (Chicago, IL)
- …and workshops. **Other information:** **Required Job Qualifications:** *Current license in Illinois as Registered Nurse ( RN ). *Ability to perform all job ... depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and...physician practices and inpatient teams to promote the effective utilization of services and coordination of care for adult,… more
- Rush University Medical Center (Chicago, IL)
- …**Other information:** **Required Job Qualifications:** * Current State of Illinois Professional Registered Nurse licensure * Graduate degree in nursing * o ... may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care… more
- Elevance Health (Chicago, IL)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing. + Correlates review findings with ... ** Nurse Audit Sr** **Location:** This position will work...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… 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 ... major office (PulsePoint) location listed above. The **Medical Management Nurse ** is responsible for review of the...an equivalent background. + Current active, valid and unrestricted RN license and/or certification to practice as a health… more
- Prime Healthcare (Elgin, IL)
- …the Clinical Manager. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Current and valid state Registered Nurse license. 2. Five (5) years of experience in ... the direction and supervision of the Clinical Manager, the RN Assessment Coordinator is responsible for conducting and coordinating...acute hospital setting in a Utilization Review , Case Management, business office or… more