- 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
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + 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)
- …**Work Schedule:** 8 Hr (8:00:00 AM - 4:30:00 PM) **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care for ... 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
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …works closely with the VISN's Office of Community Care division for up-to-date utilization review standards to ensure proper authorizations are issued and ... patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness and conformity with… more
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The ED Nurse Manager at Gottlieb Memorial Hospital is a registered professional nurse , ... groups to ensure safe, ethical, and quality patient/family centered care. The ED Nurse Manager promotes MAGIS behavior within the organization and patient care area;… more
- Symetria Recovery (Des Plaines, 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
- Fresenius Medical Center (Downers Grove, 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 (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
- Elevance Health (Chicago, IL)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- AdventHealth (La Grange, IL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes… more
- AdventHealth (Bolingbrook, IL)
- …for:** _AdventHealth Bolingbrook Hospital_ **The role you'll contribute:** This Registered Nurse candidate audits every bariatric surgery patient's Epic chart post ... follow-up data components for the program through the effective utilization of the hospital medical record systems and through...RN experience required in a healthcare setting. . Registered Nurse of Illinois, BSN Preferred. . 1 year of… more
- Rush Copley Medical Center (Aurora, IL)
- …skills. + Knowledge of concepts and principles of Care Management and/or Utilization Review . Hospital experience preferred. Rush is an equal opportunity ... **Position Summary** The registered nurse is responsible for the assessment, planning, implementation,...patient admission and level of care. + Provides continuous review of medical necessity. Notifies physician and collaborates with… more
- Rush University Medical Center (Chicago, IL)
- …- 5:00:00 PM) **Summary:** The Supervisor, Organ Placement RN is a registered nurse who provides leadership and direct oversite to the Organ Placement Clinical ... from an accredited nursing program required. * Current State of Illinois Registered Nurse licensure required. * Ability to perfom the Transplant Coordinator or Organ… more
- AdventHealth (Glendale Heights, IL)
- …degree required** * **One year of position-related experience required (ie, utilization review );** **_Two years of position-related experience preferred_** ... **LICENSURE, CERTIFICATION OR REGISTRATION:** * Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or job transfer date… more
- CVS Health (Chicago, IL)
- …plan's subject matter expert in medical management operations, including Utilization Management, Care Management, Care program development and implementation, Social ... such as monitoring report owners and the timely quality review of these reports and works with COO and...behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + Illinois… more