- Cognizant (Springfield, IL)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Springfield, IL)
- … + Education: Diploma RN acceptable;Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse , 1+ years of clinical experience in acute or ... post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have...Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse , 1+ years of clinical… more
- CVS Health (Springfield, IL)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules...will include weekends, holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to… more
- Fresenius Medical Center (Macomb, IL)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Springfield, IL)
- …including NCQA standards. **Required Qualifications** + Candidate must have an active and unrestricted Registered Nurse (RN) License in Illinois + 3+ years of ... + Bachelor's Degree in Nursing (PREFERRED) **License** + Active and unrestricted Registered Nurse (RN) License in Illinois **Anticipated Weekly Hours** 40… more
- Evolent (Springfield, IL)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Molina Healthcare (Macomb, IL)
- …and electronic medical record (EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, ... primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing… more
- CVS Health (Springfield, IL)
- …progress toward desired outcomes through assessment and evaluation. **Required Qualifications** + Active Registered Nurse IL /Compact License + Minimum 3+ years ... in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our...experience, transitions of care and discharge planning required + Registered Nurse with active state license in… more
- Highmark Health (Springfield, IL)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Springfield, IL)
- …conditions. + **Diabetes education experience** is required. + Current, unrestricted ** Registered Nurse (RN) license** ; multi-state licensure preferred. + ... health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care,… more