- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Sharecare (Springfield, IL)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...the disease management program intervention guidelines. An RN is supervised by an Operations Manager (OM). All… more
- Veterans Affairs, Veterans Health Administration (Danville, IL)
- … nurse independently provides patient-centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living with ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Molina Healthcare (Chicago, IL)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... be discussed during our interview process. This is a remote position. Work hours: Monday- Friday: 8:00am -5:00pm. Michigan...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Humana (Springfield, IL)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- Rush University Medical Center (Chicago, IL)
- …and can use past experiences to implement solutions for current situations. The Ambulatory RN 2 is a competent nurse who has mastered technical skills and ... the teaching- learning process to meet the learning and self- management needs of patients and families. 11. Assesses patient...**Position** Ambulatory RN 2 - Neurology - 1 Day a Week Remote ! **Location** US:IL:Chicago **Req ID**… more
- Highmark Health (Springfield, IL)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Guardian Life (Springfield, IL)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Highmark Health (Springfield, IL)
- … - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** +… more
- CVS Health (Springfield, IL)
- …functions, as well as be the health plan's subject matter expert in medical management operations, including Utilization Management , Care Management , ... healthcare to our members. ** This position is fully remote . Eligible candidates can live anywhere in the US,...inclusive behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of… more
- Elevance Health (IL)
- **Be Part of an Extraordinary Team** ** Nurse Medical Management I** **Location:** Remote - Candidates must reside within 50 miles or 1-hour commute each way ... experience. **Preferred skills, qualifications and experiences:** + Prior experience in inpatient Utilization Management , preferred. + 3-5 years of experience in… more
- Elevance Health (Chicago, IL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Elevance Health (Chicago, IL)
- …Health location. The ** Nurse Case Manager ll** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** Requires BA/BS… more