• RN Utilization Management

    Humana (Springfield, IL)
    **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
    Humana (01/07/25)
    - Save Job - Related Jobs - Block Source
  • Mgr Utilization Review RN

    Baylor Scott & White Health (Springfield, IL)
    …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
    Baylor Scott & White Health (01/08/25)
    - Save Job - Related Jobs - Block Source
  • Care Manager RN - Weekends (Remote)

    Highmark Health (Springfield, IL)
    …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
    Highmark Health (01/07/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Registered Nurse - Remote

    Sharecare (Springfield, IL)
    …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
    Sharecare (01/08/25)
    - Save Job - Related Jobs - Block Source
  • Care Manager Behavioral Health - Part Time…

    Highmark Health (Springfield, IL)
    …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
    Highmark Health (12/12/24)
    - Save Job - Related Jobs - Block Source
  • Case Manager RN

    CVS Health (Springfield, IL)
    …Configures the case management system to organize cases dealing with disease management and utilization review ; tracks patient progress and manages ... + Case Management experience in the insurance industry + Compact RN licensure + Certified Case Manager + Telephonic Nursing experience + Home Health… more
    CVS Health (12/31/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Behavioral…

    Humana (Springfield, IL)
    …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
    Humana (11/13/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Case Manager RN

    CVS Health (Springfield, IL)
    …current licensure in the state of Illinois - 3+ years of clinical experience as a Registered Nurse - 2+ Case Management experience - 1+ year of Discharge ... office-based meetings and/or trainings in Downers Grove IL as needed/requested by Management .** Preference for candidates residing in the Chicago, Cook County area. … more
    CVS Health (12/05/24)
    - Save Job - Related Jobs - Block Source
  • RN Clinical Consultant, Claims Shared…

    Guardian Life (Springfield, IL)
    …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
    Guardian Life (12/20/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Reviewer, Nurse - Cardiac

    Evolent (Springfield, IL)
    …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
    Evolent (01/03/25)
    - Save Job - Related Jobs - Block Source