- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Insight Global (Skokie, IL)
- …https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements 3+ years experience as a utilization review nurse Experience reviewing and ... a Clinical Denials Specialist you will be working with the denials team to review and analyze denials from a clinical perspective. This person will be responsible… more
- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Baylor Scott & White Health (Springfield, IL)
- …vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee care coordination across ... Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. +...experience + Hold a valid registration as a Registered Nurse As a health care system committed to improving… more
- Humana (Springfield, IL)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- ERP International (Scott AFB, IL)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse (RN)** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL… more
- Rush University Medical Center (Chicago, IL)
- …Offers may very depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and inpatient teams to promote ... the effective utilization of services and coordination of care for adult,...for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness… more
- Veterans Affairs, Veterans Health Administration (Danville, IL)
- …the provision of competent, evidence-based care, the psychiatric MH nurse independently provides patient-centered and recovery-oriented care, milieu management, and ... conditions. * They facilitate shift reports, warm hand-offs, and nurse -led psychoeducational groups; use therapeutic communication techniques, practice de-escalation… more
- Elevance Health (Chicago, IL)
- …clinicians and business leaders passionate about transforming American healthcare delivery. ** Nurse Reviewer I** **Location:** **Illinois. This is a remote position ... of our Elevance Health PulsePoint location in** **Chicago, Illinois** **.** The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of network… more
- ICW Group (Lisle, IL)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical...Providers. + May perform Utilization Review activities (or review … more
- Rush University Medical Center (Chicago, IL)
- …may very depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care ... The CNL provides insight regarding the microsystem for collaboration with the Clinical Nurse Specialist (CNS) on macrosystem processes and outcomes. The CNL and CNS… 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 ... modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse , Supervisor or Physician as needed. + Assesses, collaborates, and documents… more
- Blessing Hospital (Quincy, IL)
- …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. ... Quincy & Pittsfield locations + Educational assistance opportunities JOB SUMMARY + The nurse manager leads frontline nursing staff in the delivery of patient care.… 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
- 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 of a ... 10 Hour shifts **Build the Possibilities. Make an Extraordinary Impact.** The ** Nurse Medical Management I** is responsible to collaborate with healthcare providers… 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
- Ascension Health (Kankakee, IL)
- …of stay. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... Certification / Registration: + One or more of the following required: + Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date… 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
- Fresenius Medical Center (Peoria, IL)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more