- CVS Health (Springfield, IL)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CST zones **Education**… more
- CVS Health (Springfield, IL)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Springfield, IL)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Huron Consulting Group (Chicago, IL)
- …the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing ... Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, regulatory… more
- US Tech Solutions (Chicago, IL)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior...in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST… more
- Ascension Health (St. Charles, IL)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning, and utilization review. +.../ Registration: + Registered Nurse credentialed from the Illinois Board of Nursing obtained… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** The Oncology Nurse Navigator 2 is a registered nurse (RN) who works with physician ... practices and multi-disciplinary teams to promote the effective utilization of services and coordination of care for patients within the Cancer Center service line.… more
- Rush University Medical Center (Chicago, IL)
- …on the circumstances of each case. **Summary:** The Bone Marrow Transplant (BMT) Oncology Nurse Navigator 2 is a registered nurse (RN) who works collaboratively ... with physician practices and multi-disciplinary teams as to promote the effective utilization of services and coordination of care for patients within the Section of… more
- Rush University Medical Center (Chicago, IL)
- …of each case. **Summary:** The Clinical Specialist RN is an advanced practice nurse with knowledge in a specialized area of nursing who promotes quality patient ... an integrated role of practice, education, administration and research. The Clinical Nurse Specialist exemplifies the Rush mission, vision, and values and acts in… more
- Trinity Health (Silvis, IL)
- …One! (http://www.genesishealth.com/) Join the MercyOne Family! We are looking to hire a Registered Nurse ! A dedicated Charge Nurse is a registered nurse ... allocation, and collaboration with the interdisciplinary healthcare team. The Charge Nurse ensures adherence to established policies, promotes a collaborative work… more
- Rush University Medical Center (Chicago, IL)
- …may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care ... for the improvement of patient care outcomes, and resource in the management of clinically complex patients. The CNL provides insight regarding the microsystem… more
- Prime Healthcare (Evanston, IL)
- …Location:Evanston, IL 60201 Responsibilities + 24-hour administrative responsibility for the management of all nursing service functions in assigned units. + ... administration both written and verbally. + Consults with staff, physicians and Nurse Executive on nursing issues and interpretation of hospital policies to ensure… more
- Zurich NA (Schaumburg, IL)
- …medical terminology Preferred Qualifications: + 2 or more years' experience in Utilization Review, Case Management , Workers Compensation, or medical bill reviews ... Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for...order to identify any anomalies or discrepancies and ensure management has access to up to date and accurate… more
- Intermountain Health (Springfield, IL)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Evolent (Springfield, IL)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Fresenius Medical Center (Urbana, IL)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN, for a limited period of time, and ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… more
- Elevance Health (Chicago, IL)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... ** Nurse Case Manager II** **Work Schedule: M-F 8am-430pm... Case Manager I** I is responsible for care management within the scope of licensure for members with… more
- Humana (Springfield, IL)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Fresenius Medical Center (Decatur, 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 (Macomb, IL)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more