- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- Baylor Scott & White Health (Springfield, IL)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Blessing Hospital (Quincy, IL)
- …Quincy & Pittsfield locations + Educational assistance opportunities JOB SUMMARY + The Registered Nurse C3 acts as principal liaison between emergency services, ... surgical services, nursing, finance, physicians, utilization review , and medical records to ensure...management . + License/Certifications/Special Requirements: + Possesses current State RN license. + Pay Status: + NON-EXEMPT HOURLY EEO… more
- Fresenius Medical Center (Peoria, IL)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- ERP International (Scott AFB, IL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN )** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL ... Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health… more
- Highmark Health (Springfield, IL)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… 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...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… 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
- Highmark Health (Springfield, IL)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CVS Health (Springfield, IL)
- …Configures the case management system to organize cases dealing with disease management and utilization review ; tracks patient progress and manages ... + Case Management experience in the insurance industry + Compact RN licensure + Certified Case Manager + Telephonic Nursing experience + Home Health… 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
- AdventHealth (La Grange, IL)
- …skills **.** Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... documents avoidable days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes… 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 ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Prime Healthcare (Chicago, IL)
- …license. 2. Five (5) years of experience in acute hospital setting in a Utilization Review , Case Management , business office or related department. ... Under the direction and supervision of the Clinical Manager, the RN Assessment Coordinator is responsible for conducting and coordinating the completion… more
- CVS Health (Springfield, IL)
- …current licensure in the state of Illinois - 3+ years of clinical experience as a Registered Nurse - 2+ Case Management experience - 1+ year of Discharge ... office-based meetings and/or trainings in Downers Grove IL as needed/requested by Management .** Preference for candidates residing in the Chicago, Cook County area. … more
- Ascension Health (Kankakee, IL)
- …specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and ... **Details** + **Department:** Case Management + **Schedule:** Full-time, Days, 8am-4:30pm, with ability...+ One or more of the following required: + Registered Nurse credentialed from the Illinois Board… more
- Rush University Medical Center (Chicago, IL)
- …**Other information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure * National certification * Master's degree ... circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for… more
- AdventHealth (Hinsdale, IL)
- …committees.** **The value you'll bring to the team:** + **Facilitates clinical teams to review utilization and options for product selection for our Great Lakes ... experiences you'll need to succeed** **:** **EDUCATION AND EXPERIENCE REQUIRED** **:** + ** RN with Bachelor's Degree in Nursing, Management or related healthcare… more