- Elevance Health (Chicago, IL)
- …in an ambulatory or hospital setting or a minimum of 1 year of prior utilization management , medical management and/or quality management , and/or call ... required. **Preferred Skills, Capabilities, and Experiences** : + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- ChenMed (Oak Lawn, IL)
- …explain primary care provider role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for… more
- Ascension Health (Chicago, IL)
- …of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service ... **Details** + **Department:** Physician Advisor, Administration + **Schedule:** Full-time + **Hospital:** Ascension St. Joseph's Chicago (Lakeshore Drive) +… more
- Rush University Medical Center (Chicago, IL)
- …Division. The Care Management Navigator may contribute to transitional care planning, utilization review , and/or service line growth & outreach efforts for a ... Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Care Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0) **Shift:**… more
- ChenMed (Glenwood, IL)
- …join our team. The Care Coordinator will work with Care Center of Excellence, Physician Management Resources (PMR), market leaders, external clients and HMO to ... establish, maintain and support outpatient utilization management in PMR and delegated ...in ChenMed Medical Centers. Primary Duties and Responsibilities Daily review of approved and pended outpatient requests for PMR… more
- Rush University Medical Center (Chicago, IL)
- …Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Care Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0) **Shift:** ... case. **Summary:** The Nurse Care Manager 1 works with physician practices and inpatient teams to promote the effective... practices and inpatient teams to promote the effective utilization of services and coordination of care for adult,… more
- Elevance Health (Chicago, IL)
- …+ Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Elevance Health (Chicago, IL)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician -level case review of utilization requests for procedures ... The **Medical Director, Cardiology** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
- Elevance Health (Chicago, IL)
- …Associate Medical Director** **Carelon Medical Benefits Management ** **Radiology Benefit** ** Management / Utilization ** ** Review ** _A proud member of the ... Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in Illinois. Our platform… more
- Fresenius Medical Center (Gary, IN)
- …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
- Rush University Medical Center (Chicago, IL)
- …or Registered Health Information Technician (RHIT) certification in conjunction with physician based coding experience, including evaluation & management (E/M) ... incumbent will regularly conduct coding reviews of CPT, ICD-10, and modifier utilization . Provide feedback and focused educational programs on the results of… 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
- Novo Nordisk (Chicago, IL)
- …productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights ... + Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance +...would benefit in order to ensure early trial and utilization + Generates advocacy for Novo Nordisk products and… more