- 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
- Elevance Health (Chicago, IL)
- …medical decisions to members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review , of Medical Oncology ... regimens and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Elevance Health (Chicago, IL)
- ** Nurse Audit Lead** **Supports the Carelon Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- Rush University Medical Center (Chicago, IL)
- …0.9 and 1.0) **Shift:** **Shift 1** **Work Schedule:** 10 Hr **Summary:** The Nurse Care Manager 1 works with physician practices and inpatient teams to promote ... the effective utilization of services and coordination of care for adult,...for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness… 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 ... (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
- Rush University Medical Center (Chicago, IL)
- …**Work Schedule:** 8 Hr (7:00:00 AM - 5:00:00 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
- Fresenius Medical Center (Evergreen Park, IL)
- …of adjustment, along with increased risk of hospitalization and mortality. As a TCU nurse , you will help patients feel better and make more informed decisions about ... Park clinic._ _Monday-Friday, day hours._ **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation… more
- Ascension Health (Chicago, IL)
- …including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment ... of stay. + Serve as content specialist for staff in the areas of utilization criteria, appeal, and review process, and case management system documentation. +… more
- Rush University Medical Center (Chicago, IL)
- …Schedule:** 10 Hr (7:00:00 AM - 5:30:00 PM) **Summary:** The Ambulatory Clinical Nurse Leader functions as an advanced generalist providing and managing care for ... anticipator, team lead, professional, and lifelong learner. The Ambulatory Clinical Nurse Leader collaborates with nursing leadership and the healthcare team, and… 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
- 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, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… 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 ... (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
- Rush University Medical Center (Chicago, IL)
- …(7:00:00 AM - 3:30:00 PM) **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for ... readiness to learn. * Selects and promotes optimal, cost effective resource utilization and interventions. Nursing Practice * Provides formal and informal education… more
- Amergis (Chicago, IL)
- …the Enrollees care is medically complex the CBSWCC collaborates with a nurse in the provision care coordination. Completes assessments of complex health care ... may include portals, electronic medical records, claims data, plan information, utilization management information, and Milliman Care Guidelines (MCG). + Completes… more
- Teleflex (Chicago, IL)
- …territory. The incumbent is responsible for the growth of overall product utilization within their accounts including, but not limited to, selling the designated ... time in the field. * Facilitate sales growth by conducting physician, nurse , and technologist training and account in-servicing of dialysis access products. *… 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...experience, preferably in the State of Illinois. + Registered Nurse , preferably in the State of Illinois. + Experience… more
- Vyaire Medical (Chicago, IL)
- …of new products and services; make recommendations to drive client acceptance and utilization of new medical devices. Facilitate UPE's for new products. + Develop, ... Minimum 5 years clinical experience as a respiratory therapist or critical care nurse required + Ability to meet requirements in vendor credentialing services, eg… more
- Trinity Health (Maywood, IL)
- …regional and hospital nursing operations, including regionalized services for Utilization Review /Case Management, Centralized Telemetry, Nursing Professional ... care setting, preferably in a large hospital or health system. Current Registered Nurse License. **Our Commitment to Diversity and Inclusion:** Trinity Health is one… more