- 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
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Elevance Health (Chicago, IL)
- Nurse Audit Lead - Carelon Payment Integrity **Location:** The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a ... is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- Rush University Medical Center (Chicago, IL)
- …0.9 and 1.0) **Shift:** **Shift 1** **Work Schedule:** 8 Hr **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
- Rush University Medical Center (Chicago, IL)
- …**Work Schedule:** 8 Hr (8:00:00 AM - 4:30:00 PM) **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care for ... 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
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager, Emergency Room at Gottlieb Memorial Hospital is a registered professional ... nurse , conversant with the nursing process, who has 24-...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… more
- Symetria Recovery (Des Plaines, IL)
- …in the context of Evaluation/Management visits when appropriate. + Utilization of safe prescribing practices and evidence-based treatment guidelines for ... co-occurring substance use disorders. + Complete training provided on utilization and result interpretation of available diagnostic procedures (Ie Pharmacogenetic… more
- Fresenius Medical Center (Grayslake, 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 (Waukegan, 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
- Rush University Medical Center (Chicago, IL)
- …- 7:30:00 PM) **Summary:** The Supervisor, Organ Placement RN is a registered nurse who provides leadership and direct oversite to the Organ Placement Clinical ... from an accredited nursing program required. * Current State of Illinois Registered Nurse licensure required. * Ability to perfom the Transplant Coordinator or Organ… more
- CVS Health (Chicago, IL)
- …plan's subject matter expert in medical management operations, including Utilization Management, Care Management, Care program development and implementation, Social ... such as monitoring report owners and the timely quality review of these reports and works with COO and...behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + Illinois… more
- AdventHealth (Glendale Heights, IL)
- …degree required** * **One year of position-related experience required (ie, utilization review );** **_Two years of position-related experience preferred_** ... **LICENSURE, CERTIFICATION OR REGISTRATION:** * Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or job transfer date… more
- Froedtert South (Pleasant Prairie, WI)
- …implications of options with patients and families, utilizing the appropriate resources from Utilization Review and other areas. + Participates in and leads, as ... 3 years LICENSES / CERTIFICATIONS REQUIRED + Licensure to practice as a Registered Nurse in the State of Wisconsin. KNOWLEDGE, SKILLS & ABILITIES REQUIRED + Nursing… more