- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills ... medical services and/or benefit administration of post-acute determinations. The Manager , Utilization Management Nursing...to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in IL, WI, MN, SD, ND, IA,… more
- Evolent Health (Springfield, IL)
- …others. **Collaboration Opportunities** : The Lead Nurse of Utilization Management is responsible for assisting the UM Manager in supervising the ... operational productivity of the Utilization Management nurses by implementing and maintaining an efficient and...department. The UM Lead, in collaboration with the UM Manager and Director, ensures compliance with all regulatory standards… more
- Prime Therapeutics (Springfield, IL)
- …+ Clinical and Quality oversight for this program is provided by the Manager , Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years ... post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria.… more
- CVS Health (Springfield, IL)
- …the current health status of the patient. + Applies in-depth knowledge of case management and nursing practices to organize patient files in an orderly manner ... management system to organize cases dealing with disease management and utilization review; tracks patient progress...insurance industry + Compact RN licensure + Certified Case Manager + Telephonic Nursing experience + Home… more
- CVS Health (Springfield, IL)
- …Grove/Chicago or meeting with members in the field. **Position Summary** The Care Manager RN is responsible for driving and supporting care management and ... coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. **Required… more
- Sharecare, Inc. (Springfield, IL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Patient Care Technician (PCT) + Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager +… more