- 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
- 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
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **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)
- ** Nurse Reviewer I** **Location:** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training sessions, ... integration, and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out… 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
- CVS Health (Chicago, IL)
- …through integration. + Through the use of clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an approach ... that impact functionality and the member's restrictions/limitations. + Analyzes utilization , self-report and clinical data available to consolidate information and… more
- Rush University Medical Center (Chicago, IL)
- …circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of nursing practice responsible for ... information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure * National certification * Master's degree in Nursing from… more
- Rush University Medical Center (Chicago, IL)
- …**Required Job Qualifications:** Current State of Illinois Registered Nurse licensure required **Preferred Job Qualifications:** Baccalaureate degree in ... response to treatment. 3. Constantly seeks process improvement opportunities regarding supple utilization and charge captures. 4. Acts as the primary liaison between… more
- Prime Healthcare (Chicago, IL)
- …license. 2. Five (5) years of experience in acute hospital setting in a Utilization Review , Case Management, business office or related department. Experience in ... Set (MDS), and for tracking, and transmitting all data including the Resource Utilization Groups (RUGs) to the Department of Health and Human Services. The process… more
- Trinity Health (Maywood, IL)
- …ED, hospital and post-acute system resources are used appropriately and effectively. They review utilization and quality data to monitor performance of care ... Physician Partners. The Manager provides oversight and daily management of the Nurse Care Coordinators, Community Health Workers, Social Workers and other population… more
- Trinity Health (Maywood, IL)
- …**Description:** The Lead Case Manager Position reports to the Manager of Nurse Care Management. The specific duties include: Recruiting, interviewing, hiring, and ... Assists in compilation of physician profile data and regarding LOS, resource utilization , denied days, costs, case mix index, patient satisfaction and quality… more
- Prime Healthcare (Des Plaines, IL)
- Overview * Department: Utilization Management/ Case Management * Schedule: Days, 8am-4:30pm * Facility:Prime Holy Family Medical Center * Location: Des Plaines, ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license 2. Grandfathered prior to April 1, 2015.… more