- 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
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Insight Global (Skokie, IL)
- …https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements 3+ years experience as a utilization review nurse Experience reviewing and ... a Clinical Denials Specialist you will be working with the denials team to review and analyze denials from a clinical perspective. This person will be responsible… more
- Trinity Health (Maywood, IL)
- …at the Westmont office Join our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a ... the Director/Manager oversees the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral health services to… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Elevance Health (Chicago, IL)
- …and over- utilization by performing medical reviews via prepayment claims review and post-payment auditing. + Correlates review findings with appropriate ... Nurse Auditor Senior - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Rush University Medical Center (Chicago, IL)
- …0.9 and 1.0) **Shift:** **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Nurse Care Manager 1 works with physician practices and inpatient teams to promote ... the effective utilization of services and coordination of care for adult,...for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness… more
- Elevance Health (Chicago, IL)
- …based upon the needs of the business; 40 hour work week The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… more
- Elevance Health (Chicago, IL)
- ** Nurse Reviewer I** **Location:** Within 50 miles of a pulse point **Shift** : Monday - Friday from 9:30 am - 6:00 pm CST or PST The ** Nurse Reviewer I** is ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… more
- Rush University Medical Center (Chicago, IL)
- …**Work Schedule:** 8 Hr (7:00:00 AM - 5:00:00 AM) **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care for ... 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
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager, Emergency Room at Gottlieb Memorial Hospital is a registered professional ... nurse , conversant with the nursing process, who has 24-...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… 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
- Elevance Health (Chicago, IL)
- …you will make an impact:** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of treatment setting ... a minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and… more
- Elevance Health (Chicago, IL)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- Rush University Medical Center (Chicago, IL)
- …response to treatment. 3. Constantly seeks process improvement opportunities regarding supple utilization and charge captures. 4. Acts as the primary liaison between ... brings topics for potential investigation to the Nursing Quality/UAC group. Coordinates peer review of nursing quality and safety issues for the service line. 11.… more
- Symetria Recovery (Des Plaines, IL)
- …in the context of Evaluation/Management visits when appropriate. + Utilization of safe prescribing practices and evidence-based treatment guidelines for ... co-occurring substance use disorders. + Complete training provided on utilization and result interpretation of available diagnostic procedures (Ie Pharmacogenetic… more
- Rush University Medical Center (Chicago, IL)
- …- 7:30:00 PM) **Summary:** The Supervisor, Organ Placement RN is a registered nurse who provides leadership and direct oversite to the Organ Placement Clinical ... from an accredited nursing program required. * Current State of Illinois Registered Nurse licensure required. * Ability to perfom the Transplant Coordinator or Organ… more
- CVS Health (Chicago, IL)
- …plan's subject matter expert in medical management operations, including Utilization Management, Care Management, Care program development and implementation, Social ... such as monitoring report owners and the timely quality review of these reports and works with COO and...behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + Illinois… more
- Amergis (Chicago, IL)
- …may include portals, electronic medical records, claims data, plan information, utilization management information, and Milliman Care Guidelines (MCG). + Completes ... and Care Coordination policy and procedure. + Integrates information from claims review , notes, screenings, assessments and Medical Home teams in care plan. +… more