- 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
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... in this remote position. **Here's what you will experience working as a Utilization Review Author:** + 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
- Rush University Medical Center (Chicago, IL)
- …at our Rush benefits page . **Summary:** The Bone Marrow Transplant (BMT) Oncology Nurse Navigator 2 is a registered nurse (RN) who works collaboratively with ... physician practices and multi-disciplinary teams as to promote the effective utilization of services and coordination of care for patients within the Section of Bone… more
- Rush University Medical Center (Chicago, IL)
- **Job Description** **Med Surg Oncology Clinical Nurse Leader** **Location:** Chicago, IL **Hospital:** RUSH University Medical Center **Department:** 14 W Tower ... **Work Schedule:** 8 Hr (7:00:00 AM - 3:30:00 PM) **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care for… more
- Symetria Recovery (Chicago, 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
- 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.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… 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
- 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
- Molina Healthcare (Kenosha, WI)
- …a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... of Interqual / MCG guidelines. WI or COMPACT RN LICENSURE IS REQUIRED within 30 days of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is preferred._** **_Excellent computer skills and attention… more
- CenterWell (Buffalo Grove, IL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… 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
- Veterans Affairs, Veterans Health Administration (Union Grove, WI)
- …Sexual Trauma, etc. The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (Clinic Utilization ... teamlet. Members of the teamlet include the MSA, a Registered Nurse Care Manager, a Licensed Practical Nurse / Licensed Vocational Nurse , and a Primary Care… more
- Rush University Medical Center (Chicago, IL)
- …response to treatment. 3. Constantly seeks process improvement opportunities regarding supple utilization and charge captures. 4. Acts as the primary liaison between ... brings topics for potential investigation to the Nursing Quality/UAC group. Coordinates peer review of nursing quality and safety issues for the service line. 11.… more
- Veterans Affairs, Veterans Health Administration (North Chicago, IL)
- …areas include: insurance identification and verification; enrollment; eligibility; utilization review ; precertification/ certification; billing, coding, ... other matter relating to the business integrity of VHA operations. Performs quality review audits on these areas to ensure that the facility business operations are… 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
- Humana (Kenosha, WI)
- …while maintaining compliance of state mandated timelines & appropriate professional utilization of LTCFS Instruction Manual. + Effectively maintain updates of status ... adherence of State of WI and iCare LTCFS timeframes. Review Level of Care for iCare members including follow-up...or have a license to practice as a registered nurse in Wisconsin. + Knowledge of public long-term care,… more