- 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 ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- Prime Healthcare (Elgin, IL)
- … nurse staff, coding staff and hospital management staff. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/179182/regional- utilization - ... for the oversight of third-party payer utilization review (UR) and the denial management (DM) process. + The Manager functions as an appeal/denial… more
- Trinity Health (Maywood, IL)
- …is Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… more
- AdventHealth (Glendale Heights, IL)
- …**The role you'll contribute:** Provides health care services regarding admissions, case management , discharge planning and utilization review for Behavioral ... Behavioral Health RN experience strongly preferred + Experience in utilization review strongly preferred + Registered Nurse credentialed from the Illinois… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... in this remote position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission and continued stay reviews… 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 ... experience in acute hospital setting. + Strong clinical expertise. + Prior experience in utilization management or case management preferred. + Ability to… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …on areas assigned, including review of patient incident report reviews, utilization management reviews, medical record reviews for evidence of required ... to develop, implement, refine, and maintain a comprehensive quality management /improvement program. Responsibilities The incumbent is responsible for the following:… more
- Rush University Medical Center (Chicago, IL)
- …Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Care Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0) **Shift:** ... depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and...physician practices and inpatient teams to promote the effective utilization of services and coordination of care for adult,… 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
- 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 ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager of our Emergency Department at Gottlieb Memorial Hospital is a registered ... professional nurse , conversant with the nursing process, who has 24x7...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… more
- Blessing Hospital (Quincy, IL)
- …principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review , and medical records to ensure appropriate bed ... ON RELEVANT EXPERIENCE COMPETITIVE BENEFITS Click here (https://www.blessinghealth.org/sites/default/files/users/user15/HR\_2023\_Total\_Rewards\_Guide.pdf) to review our complete Total Rewards Guide. + 403b +… 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 (Evergreen Park, 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
- Prime Healthcare (Kankakee, IL)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently ... PA, or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical ...interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management … more
- Evolent (Springfield, IL)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- CenterWell (Pingree Grove, IL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … 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 ... provides leadership and consultation to company facilities in the clinical review , evaluation and procurement of products and leads multi-disciplinary teams to… more
- AdventHealth (La Grange, IL)
- …documents avoidable days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient.... Health-related Master's degree or MSN . Prior Care Management / Utilization Management experience **LICENSURE, CERTIFICATION… more
- Elevance Health (Chicago, IL)
- …PulsePoint locations. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of high-tech diagnostic ... Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and… more