- Elevance Health (Chicago, IL)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- Molina Healthcare (Kenosha, WI)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level ... quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,...Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any… more
- Walworth County (Elkhorn, WI)
- Advanced Practice Psychiatric Nurse Practitioner (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/4713186) Apply Advanced Practice ... Psychiatric Nurse Practitioner (HHS) Salary $49.79 - $64.50 Hourly Location...INCLUDE: Formal Walworth County Electronic Application Education & Experience Review Verification of State Licensure Verification of Driver License… more
- Froedtert South (Pleasant Prairie, WI)
- Nurse Practitioner Froedtert South Pleasant Prairie, WI (Onsite) Full-Time Apply Now Job Details Nurse Practitioner - Obstetrics & Gynecology Froedtert South ... Medical Group Froedtert South has an exciting opportunity for a Nurse Practitioner to join a patient-centered OB/GYN practice. The position will have an average of… 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 ... 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
- 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 ... of care for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness by reviewing plans… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records ... **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims. +… more
- Rush University Medical Center (Chicago, IL)
- …position. Offers may vary depending on the circumstances of each case. **Summary:** The Nurse Care Manager is an Illinois licensed Registered Nurse who provides ... a diverse role as a clinician, educator, care coordinator and advocate. The Nurse is an expert in chronic disease management, prevention, health maintenance, and… more
- KPH Healthcare Services, Inc. (Hoffman Estates, IL)
- …**Job Summary:** Provides services to clients in accordance with the State Nurse Practice Act, Agency policy, and accepted professional standards of practice. The ... Registered Nurse provides nursing services utilizing a comprehensive base of...accidents and promote + Notifies supervisor of need for review and/or training related to equipment, procedures, or safety/infection… more
- PCI Pharma Services (Rockford, IL)
- …and shape the future of PCI. Job Title: Occupational Health Nurse Locations: **Rockford - Assembly** Business Type: **Other** Department/Function: **Safety** Reports ... support PCI's Health & Safety programs. The Occupational Health Nurse will partner with site departments to assist and...Monitor workers' health through routine screenings, hearing tests, PAPR review , and other fit to work assessments. + Assist… more
- BioLife Plasma Services (Addison, IL)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. _BioLife Plasma Services is a subsidiary ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- Mosaic (Rockford, IL)
- …LOVE working with a team that puts people first. We're looking for a Registered Nurse to join our team! With so many moving pieces, Mosaic relies heavily on the ... according to Mosaic policies and state licensing requirements. * Maintain and review medical records of individuals served to monitor pertinent concerns and provide… more
- Elevance Health (Chicago, IL)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the… more
- Elevance Health (Chicago, IL)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
- Elevance Health (Chicago, IL)
- ** Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** Expert research nurse who leads the provision of clinical care within the context of a ... publications. 16. May act as a nursing representative on the Protocol Review and Monitoring Committee, Data Safety Monitoring Board and other relevant committees.… more
- Ascension Health (Elgin, IL)
- …functional resource and performs similar duties with staff. + Assign, monitor, and review progress of work and compliance with policies and/or procedures. + Oversee ... of assigned associates. + May provide input in the review and evaluation of staff performance. + Work with...date. American HeartAssociation or American Red Cross accepted.* Registered Nurse credentialed from the Illinois Board of Nursing obtained… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …in a medical-surgical setting. Case Management, discharge planning, and utilization review experience required. Skill, Knowledge and Abilities: Ability to manage and ... work with staff, patients, and families of varied backgrounds. + Education: Registered Nurse , ADN or BSN. + Licensure: Current WI RN licensure required. +… more
- Fresenius Medical Center (Zion, IL)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical demands and work… more