- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...and may be implemented in the future._ **Position Level** Manager **Country** United States of America At Huron, we're… more
- CenterWell (Springfield, IL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Blessing Hospital (Quincy, IL)
- …processes and procedures + I CARE standards of behavior + Collaborates with the nurse manager in budget development, utilization , evaluation, and adjustment ... + 24/7 Wellness Center access + Educational assistance opportunities JOB SUMMARY The associate nurse manager in collaboration with the nurse manager … more
- Blessing Hospital (Quincy, IL)
- …processes and procedures + I CARE standards of behavior + Collaborates with the nurse manager in budget development, utilization , evaluation, and adjustment ... unit-based Pharmacist, Respiratory Therapist, Physical Therapist, and an Unit-based Educator. The associate nurse manager in collaboration with the nurse … more
- AdventHealth (Hinsdale, IL)
- …Street, Hinsdale, IL 60521 **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and the ... and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and… more
- CVS Health (Springfield, 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)
- ** Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager II** is responsible for...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- Fresenius Medical Center (Macomb, IL)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... leading your business, and advanced leadership. As a Clinical Manager , you may advance your career into an Area...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Fresenius Medical Center (Decatur, 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
- CVS Health (Springfield, IL)
- …it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case ... through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and… more
- Elevance Health (Chicago, IL)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... time,** **with rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of… more
- Fresenius Medical Center (Urbana, IL)
- …of time, and for specific additional duties, as assigned by the Program Manager . The Inpatient Services Charge Nurse ensures appropriate provision of Acute ... **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the...their direct supervision and submit results to the Program Manager for review . + Ensure all Acute… 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 ... microsystem. The CNL is a point of care expert clinician, outcomes manager , client advocate, educator, information manager , system analyst/risk anticipator, team… more
- Highmark Health (Springfield, IL)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- CenterWell (Joliet, IL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- AdventHealth (La Grange, IL)
- …Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse (RN) Required + Certified Case Manager (CCM) Preferred + Accredited ... AdventHealth La Grange Hospital **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and… more
- BJC HealthCare (Belleville, IL)
- …nursery, medical and surgical services plus critical care. Care Management includes Utilization Management ( Utilization Review ), Discharge Planning, Social ... Services, Clinical Outcomes (Care Managers), Discharge Transition Coaches, Nurse Practitioners, and Clinical Documentation Improvement. **Preferred Qualifications** **Role… more
- Carle Health (Urbana, IL)
- Overview The Nurse Manager , OR Intraoperative has leadership accountability for planning, facilitating and monitoring the day-to-day activities and functions of ... Operating Room. Responsible for planning, organizing, delegating, coordinating staff utilization , budgeting, and marketing OR services. Directly supervises nursing… more
- Carle Health (Champaign, IL)
- …patient care outcomes. The incumbent will have a deep understanding of utilization review and case management principles, case management best practices, ... experience 2+ years Responsibilities Maintain current knowledge of case management and utilization review trends including the entire continuum of care within… more
- Molina Healthcare (Naperville, IL)
- …supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral ... requirements. * Actively participates in the department auditing program to review , communicate findings and identify opportunities for improved quality and… more