- 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
- Lincoln Financial Group (Springfield, IL)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… 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
- Carle (Urbana, IL)
- Utilization Management Coord + Department: HA - Medical UM & Systems + Entity: Health Alliance + Job Category: Nursing + Employment Type: Full - Time + Job ID: 42594 ... No Email a Friend Save Save Apply Now Position Summary: The Utilization Management Coordinator RN is responsible for implementing medical utilization … 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
- 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
- Lumeris (IL)
- …in the process. Additionally, we can easily send pertinent documents to you for your review . Once you create the account, you may apply to any position you feel is ... re-enter information. Thank you for your interest in Lumeris. **Position:** Nurse Practitioner **Position Summary:** Responsible for providing exceptional care to… 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
- 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)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... **Additional Information** Nurse CARE Manager (CARE - Coordinated Action and...that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates… more
- Carle (Urbana, IL)
- …agencies and payers to plan and execute a safe discharge* Collaborates with Utilization Management team on continued stay review . + Discharge Planning* ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
- Evolent Health (Springfield, IL)
- …with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. + ... Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Symetria Recovery (Chicago, IL)
- …and development on procedures related to nursing duties + Partner with Utilization Review and psychiatry providers to process medication prior authorizations ... surrounding nursing team management and dispensary operations. + Works with the Nurse Leads and Program Directors to create monthly nursing schedule to ensure… 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
- Carle (Urbana, IL)
- …role will focus on nursing process, physician communication, case management and resource utilization . Special Summer Incentive * Sign on bonus for for nurses with 1 ... College Diploma in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse (RN) License Current licensure in good standing as a Registered… more
- Carle (Urbana, IL)
- … issues in appropriate locations, including but not limited to: case management/ utilization review software and the multidisciplinary plan of care document ... of start date CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse (RN) License Illinois upon hire and Accredited Case...well and has what they need for success. Initial utilization review for emergency room patients being… more
- Carle (Urbana, IL)
- …on each applicable transfer, completes documentation per hospital guidelines.* Performs admission Utilization review on all direct admissions & transfers to ... EMTALA guidelines). Actively collaborates with providers, nursing, and case management/ utilization management to ensure appropriate patient placement for optimal… more