- 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
- Ascension Health (Minooka, IL)
- …additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning, and utilization review . + ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Elevance Health (Chicago, IL)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + 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
- Lincoln Financial Group (Springfield, IL)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Carle (Urbana, IL)
- Utilization Management Coord + Department: HA - Medical UM & Systems + Entity: Health Alliance + Job Category: Nursing + Employment Type: Full - Time + Job ID: ... Requirements: No Email a Friend Save Save Apply Now Position Summary: The Utilization Management Coordinator RN is responsible for implementing medical … more
- Ascension Health (Chicago, IL)
- …functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management , CareCoordination, ... specialist for staff in the areas of utilization criteria, appeal, and review process, and case management system documentation. + Develop staff schedule and… 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
- 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** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- AdventHealth (Hinsdale, 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)
- …**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 ... for the improvement of patient care outcomes, and resource in the management of clinically complex patients. The CNL provides insight regarding the microsystem… 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 Heights, 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
- Marriott (Springfield, IL)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- Carle (Urbana, IL)
- …on insufficient clinical documentation to support the level of care, utilization review , determination that a treatment is investigational/experimental, and/or ... Save Save Apply Now Position Summary: Remote after orientation The Clinical Denial Management - RN participates in clinical review and development of… more
- Carle (Urbana, IL)
- …payers to plan and execute a safe discharge* Collaborates with Utilization Management team on continued stay review . + Discharge Planning* Collaborates with ... knowledge of financial and reimbursement processes to facilitate medical cost management , including best practices, effective utilization of resources, linking… more
- Kepro (IL)
- …reports for clients. + Identify patterns and trends in clinical case and utilization management performance. + Maintain the Department's Quality Management ... + Master's degree in nursing. + 1+ years of utilization management experience. + Formal training or...Organization for Standardization [ISO], Six Sigma). + Knowledge of Utilization Review Accreditation Commission (URAC), National Committee… more
- AdventHealth (Hinsdale, IL)
- …documents avoidable days, and facilitates progression of care. . Collaborates with Utilization Management staff for collaboration on patient status changes and ... (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
- Carle (Urbana, IL)
- …utilization issues in appropriate locations, including but not limited to: case management / utilization review software and the multidisciplinary plan of ... Work Location: Carle Urbana Forum + Nursing Specialty: Case Management + Secondary Job Category: Nursing + Weekend Requirements:...well and has what they need for success. Initial utilization review for emergency room patients being… more
- Carle (Urbana, IL)
- …CMS, EMTALA guidelines). Actively collaborates with providers, nursing, and case management / utilization management to ensure appropriate patient placement ... on each applicable transfer, completes documentation per hospital guidelines.* Performs admission Utilization review on all direct admissions & transfers to… more