- 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.... management , and budget control. Departments involved are Utilization Management , Case Management , and… more
- Humana (Springfield, IL)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Springfield, IL)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Evolent (Springfield, IL)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Springfield, IL)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- CVS Health (Springfield, IL)
- …in the state of Illinois - 3+ years of clinical experience as a Registered Nurse - 2+ Case Management experience - 1+ year of Discharge Planning experience ... 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 (Springfield, IL)
- …functions, as well as be the health plan's subject matter expert in medical management operations, including Utilization Management , Care Management , ... services and the enterprise broadly. + Overseeing the analysis, management , execution and staffing for all health services operations...such as monitoring report owners and the timely quality review of these reports and works with COO and… more
- Veterans Affairs, Veterans Health Administration (Springfield, IL)
- …care. In addition, coordinates and promotes service level Quality Improvement and Utilization Review by stimulating parent services. Ensures that overall quality ... and comprehensive services and communicates these to staff physicians, nurse practitioners, physician assistants and other members of Ambulator... management is the goal for all Ambulatory care staff.… more