- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in...position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform… 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)
- …**Location:** Chicago, IL **Hospital:** RUSH University Medical Center **Department:** Care Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0) ... **Shift:** **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Nurse Care Manager 1 works with physician practices and...physician practices and inpatient teams to promote the effective utilization of services and coordination of care for adult,… more
- Elevance Health (Chicago, IL)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… 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 ... for the improvement of patient care outcomes, and resource in the management of clinically complex patients. The CNL provides insight regarding the microsystem… more
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager, Emergency Room at Gottlieb Memorial Hospital is a registered professional ... nurse , conversant with the nursing process, who has 24-...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… more
- Symetria Recovery (Des Plaines, IL)
- …or other needed documentation. + Utilize psychotherapy in the context of Evaluation/ Management visits when appropriate. + Utilization of safe prescribing ... co-occurring substance use disorders. + Complete training provided on utilization and result interpretation of available diagnostic procedures (Ie Pharmacogenetic… more
- Fresenius Medical Center (Chicago, IL)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- AdventHealth (La Grange, IL)
- …documents avoidable days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient.... Health-related Master's degree or MSN . Prior Care Management / Utilization Management experience **LICENSURE, CERTIFICATION… more
- Rush University Medical Center (Chicago, IL)
- …- 7:30:00 PM) **Summary:** The Supervisor, Organ Placement RN is a registered nurse who provides leadership and direct oversite to the Organ Placement Clinical ... Coordinators and Referral Management team within the Transplant department. The Supervisor provides...nursing program required. * Current State of Illinois Registered Nurse licensure required. * Ability to perfom the Transplant… more
- CVS Health (Chicago, 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
- 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