- 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
- 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
- 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
- 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
- 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 (Chicago, 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
- Prime Healthcare (Chicago, IL)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... 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 staff. 6.… 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
- Rush University Medical Center (Chicago, IL)
- …circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for ... information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure * National certification * Master's degree in Nursing from… more
- Rush University Medical Center (Chicago, IL)
- …**Required Job Qualifications:** Current State of Illinois Registered Nurse licensure required **Preferred Job Qualifications:** Baccalaureate degree in ... response to treatment. 3. Constantly seeks process improvement opportunities regarding supple utilization and charge captures. 4. Acts as the primary liaison between… more
- Molina Healthcare (Chicago, IL)
- …staffing and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals and Grievances experience and a clinical background. The… more
- Prime Healthcare (Chicago, IL)
- …license. 2. Five (5) years of experience in acute hospital setting in a Utilization Review , Case Management, business office or related department. Experience in ... Set (MDS), and for tracking, and transmitting all data including the Resource Utilization Groups (RUGs) to the Department of Health and Human Services. The process… more