- 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
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... in Annapolis, MD + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the system, reporting to the Director of … more
- Rush University Medical Center (Chicago, IL)
- …on the circumstances of each case. **Summary:** The Bone Marrow Transplant (BMT) Oncology Nurse Navigator 2 is a registered nurse (RN) who works collaboratively ... with physician practices and multi-disciplinary teams as to promote the effective utilization of services and coordination of care for patients within the Section of… more
- Elevance Health (Chicago, IL)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... time,** **with rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of… 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
- AdventHealth (Hinsdale, IL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial… more
- Elevance Health (Chicago, IL)
- ** Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... complete the assessment within 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager II** is responsible for care management within the scope of… 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
- Molina Healthcare (Chicago, IL)
- …supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral ... requirements. * Actively participates in the department auditing program to review , communicate findings and identify opportunities for improved quality and… more
- Trinity Health (Berwyn, IL)
- …an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general supervision, manages Utilization ... under the supervision of the clinical team per protocol. Refers requests to the nurse reviewer or medical director if criteria or guidelines not met. This position… more
- Rush University Medical Center (Chicago, IL)
- …circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for ... information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure * National certification * Master's degree in Nursing from… more
- AdventHealth (Hinsdale, IL)
- …by the Sexual Assault Survivors Emergency Treatment Act (SASETA), the Illinois Nurse Practice Act, the International Association of Forensic Nurses Scope and ... selecting and preparing nurses for the SANE role. + Leads monthly peer review of SANE cases, audits all sexual assault documentation, communicates issues with other… more
- Prime Healthcare (Chicago, IL)
- …license. + Five (5) years of experience in acute hospital setting in a Utilization Review , Case Management, business office or related department. Experience in ... Set (MDS), and for tracking, and transmitting all data including the Resource Utilization Groups (RUGs) to the Department of Health and Human Services. The process… more
- Deloitte (Chicago, IL)
- …nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health ... in nursing, medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical Documentation Specialist - CCDS… more
- ChenMed (Glenwood, IL)
- …PCPs, Dialysis units and vascular or inpatient care facilities. + Ability to review patient charts, provide assessments and recommendations for care plan. + Enhances ... home dialysis utilization for patients with emphasis on increasing de-novo start...**EDUCATION AND EXPERIENCE CRITERIA:** + Licensed Physician Assistant or Nurse Practitioner with 5+ years of nephrology experience +… more
- ChenMed (Berwyn, IL)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... CRITERIA: + ARNP or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of practice required + Board certification by… 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 ... you'll bring to the team:** + Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge… more