- Cognizant (Springfield, IL)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Springfield, IL)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CT zones **Education**… more
- CVS Health (Springfield, IL)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Springfield, IL)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function - Gathers clinical information and ... + **M** anaged care experience + Discharge planning experience + Utilization Management experience **Education** ASN Required, BSN Preferred **Anticipated… more
- US Tech Solutions (Chicago, IL)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. + Considers all documented...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- CVS Health (Springfield, IL)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Centene Corporation (Springfield, IL)
- …central or eastern time zone with experience in mental health settings and utilization management / review.** Department: PHCO BH UM supporting IL Meridian ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …CC Coordinator possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... Summary The Community Care EHRM Clinical Care Coordinator acts as subject matter expert...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and ... The CNL provides insight regarding the microsystem for collaboration with the Clinical Nurse Specialist (CNS) on macrosystem processes and outcomes. The… more
- Centene Corporation (Springfield, IL)
- …as some experience in each of the following areas: acute care, utilization management (UM), InterQual knowledge, and discharge planning knowledge. **Additional ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...and actions taken on member medical records in health management systems according to utilization management… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Cicero, IL)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Fresenius Medical Center (Chicago Heights, IL)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Sharecare (Springfield, IL)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Springfield, IL)
- …in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. - Provides ... to function in clinical setting with diverse cultural dynamics of clinical staff and patients. - Registered Nurse (RN) required. **Preferred Qualifications**… more
- CVS Health (Springfield, IL)
- …in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. - Provides ... care, clinical , or health care related field. - 1 year of project management experience. - Registered Nurse (RN) license in the state of their residence.… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** The Oncology Nurse Navigator 2 is a registered nurse (RN) who works with physician ... practices and multi-disciplinary teams to promote the effective utilization of services and coordination of care for patients within the Cancer Center service line.… more
- CVS Health (Springfield, IL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …Code Medication Administration Coordinator, Automated Data Processing Applications Coordinator Registered Nurse , etc. as deemed necessary to support clinical ... Summary The Informaticist Registered Nurse , under the Chief of Staff, oversees the...overall coordination, planning, organization, analysis, and evaluation of change management practices related to the EHRM. Responsibilities The RN… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- Summary The Registered Nurse (RN), Infusion Clinic, is a clinical expert who uses advanced specialized knowledge and judgement for delivery of high quality and ... to oncology patients and their families. They oversee the administration and management of various medical procedures and treatments in the oncology setting,… more