- GIBSON AREA HOSPITAL (Gibson City, IL)
- …Type Full Time Salary Range $32.00 - $48.00 Hourly Description JOB TITLE: UTILIZATION REVIEW /CASE MANAGEMENT - Nurse DEPARTMENT: CASE MANAGEMENT (QUALITY) ... GENERAL SUMMARY The Utilization Review /Case Management Nurse is directly responsible for review of patient admissions for severity of illness and… more
- 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
- Trinity Health (Maywood, IL)
- …is Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… more
- ICW Group (Lisle, IL)
- …AND SKILLS** Understanding of Workers' Compensation, Workers' Compensation Managed Care processes, Utilization Review , Telephonic Nurse Case Management, and ... in tracking, resolution gathering, and trending of cost management issues related to bill review , case management and utilization review . + Works closely… more
- Cognizant (Springfield, IL)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Centene Corporation (Springfield, IL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... time zone with experience in mental health settings and utilization management / review .** Department: PHCO BH...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (IL)
- …in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals ... **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and… more
- Zurich NA (Schaumburg, IL)
- …medical terminology Preferred Qualifications: + 2 or more years' experience in Utilization Review , Case Management, Workers Compensation, or medical bill reviews ... Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL… more
- Blessing Hospital (Quincy, IL)
- …and procedures + I CARE standards of behavior + Collaborates with the nurse manager in budget development, utilization , evaluation, and adjustment + Maintenance ... BASED ON RELEVANT EXPERIENCE COMPETITIVE BENEFITS Click here (https://www.blessinghealth.org/benefits) to review our complete Total Rewards Guide. + 403b + matching… more
- Blessing Hospital (Quincy, IL)
- …and procedures + I CARE standards of behavior + Collaborates with the nurse manager in budget development, utilization , evaluation, and adjustment + Maintenance ... BASED ON RELEVANT EXPERIENCE COMPETITIVE BENEFITS Click here (https://www.blessinghealth.org/benefits) to review our complete Total Rewards Guide. + 403b + matching… more
- ICW Group (Lisle, IL)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical...Providers. + May perform Utilization Review activities (or review … more
- CVS Health (IL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Elevance Health (Chicago, IL)
- **Appeals Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... of clinical domains, including radiology, cardiology and oncology. The **Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out of network… more
- Blessing Hospital (Quincy, IL)
- …BENEFITS Click here (https://www.blessinghealth.org/sites/default/files/users/user15/HR\_2023\_Total\_Rewards\_Guide.pdf) to review our complete Total Rewards Guide. ... RELEVANT EXPERIENCE NURSE MANAGER COMPETITIVE...+ I CARE standards of behavior + Budget development, utilization , evaluation, and adjustment + Maintenance of a healthy… 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
- Sharecare (Springfield, IL)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Fresenius Medical Center (Spring Valley, IL)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse , Supervisor or Physician as needed. + Assesses, collaborates, and documents… more
- CVS Health (IL)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more
- ChenMed (Oak Lawn, IL)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner must demonstrate the ability to function both...or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of practice required… 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
