- Prime Healthcare (Aurora, IL)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189384/ utilization - review - nurse ... or payer setting within the last 5 years. 2. Utilization review and denial management experience required.... and denial management experience required. 3. Current state RN licensure required. 4. Must be able to communicate… more
- Fresenius Medical Center (Ottawa, IL)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) ... for new employees who meet the RN CAP 2 criteria or attained through...the Clinical Educator, Preceptor or in collaboration with other Registered Nurses. + Performs ongoing, systematic collection and analysis… more
- Fresenius Medical Center (Plainfield, 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
- Morris Hospital (Morris, IL)
- …using evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure ... and federal regulatory requirements and payer/reimbursement methodologies. + Licensure as Registered Nurse in Illinois. + DCFS Mandated Reporter Certificate… more
- Ascension Health (Kankakee, IL)
- …/ Certification / Registration: + One or more of the following required: + Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to ... Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary:** The registered nurse is responsible for the assessment, planning, implementation, and evaluation of the patients' status, plan of care, and ... and is in accordance with policies and procedures. The registered nurse is expected to uphold the...patient admission and level of care. + Provides continuous review of medical necessity and SI/IS criteria. Notifies physician… more