- Elevance Health (Chicago, IL)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- Rush University Medical Center (Chicago, IL)
- …may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and managing care ... 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
- Rush University Medical Center (Chicago, IL)
- …Offers may very depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and inpatient teams to promote ... of care for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness by reviewing plans… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records ... **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims. +… more
- Rush University Medical Center (Chicago, IL)
- …position. Offers may vary depending on the circumstances of each case. **Summary:** The Nurse Care Manager is an Illinois licensed Registered Nurse who provides ... a diverse role as a clinician, educator, care coordinator and advocate. The Nurse is an expert in chronic disease management, prevention, health maintenance, and… more
- KPH Healthcare Services, Inc. (Chicago, IL)
- …**Job Summary:** Provides services to clients in accordance with the State Nurse Practice Act, Agency policy, and accepted professional standards of practice. The ... Registered Nurse provides nursing services utilizing a comprehensive base of...accidents and promote + Notifies supervisor of need for review and/or training related to equipment, procedures, or safety/infection… more
- BioLife Plasma Services (Harwood Heights, IL)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. _BioLife Plasma Services is a subsidiary ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager of our Emergency Department at Gottlieb Memorial Hospital is a registered ... professional nurse , conversant with the nursing process, who has 24x7...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… 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.** ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the… more
- Elevance Health (Chicago, IL)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
- Elevance Health (Chicago, IL)
- ** Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** Expert research nurse who leads the provision of clinical care within the context of a ... publications. 16. May act as a nursing representative on the Protocol Review and Monitoring Committee, Data Safety Monitoring Board and other relevant committees.… more
- Ascension Health (Elgin, IL)
- …functional resource and performs similar duties with staff. + Assign, monitor, and review progress of work and compliance with policies and/or procedures. + Oversee ... of assigned associates. + May provide input in the review and evaluation of staff performance. + Work with...date. American HeartAssociation or American Red Cross accepted.* Registered Nurse credentialed from the Illinois Board of Nursing obtained… 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 ... including efficient utilization of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and on-site state or… more
- Fresenius Medical Center (Chicago, IL)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical demands and work… more
- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Utilization Review Author** , you will help our hospital clients by working ... case reviews. Every day you will, determine the appropriate cases for review , utilizing client-specific guidelines. Upon identification of a case, you will ensure… more
- Prime Healthcare (Evanston, IL)
- …status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. ... Graduate, Dental Graduate, PA, or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical Review Coordinator - I required. 3.… more
- AdventHealth (Glendale Heights, IL)
- …+ Behavioral Health RN experience strongly preferred + Experience in utilization review strongly preferred + Registered Nurse credentialed from the Illinois ... health care services regarding admissions, case management, discharge planning and utilization review for Behavioral Health **The value you'll bring to the team:** +… more
- Trinity Health (Maywood, IL)
- …toward the integrity of clinical documentation through the roles of reviewer , educator and consultant. Facilitates the overall quality, completeness, accuracy and ... integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the healthcare team,… more