- Elevance Health (Chicago, IL)
- …across an expanding set of clinical domains, including radiology, cardiology and oncology._ ** Nurse Reviewer I** **Location:** This is a virtual position open to ... in CDT, regardless of your individual time zone. The ** Nurse Reviewer I** is responsible for conducting...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse 123154 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL ... standards by adhering to Best Practices and participating in monthly peer review audits. + Ensure legal compliance by following regional, country and/or local… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… 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
- 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 ... of care for adult, geriatric, neonate, pediatric and adolescent patients. The Nurse Care Manager 1 contributes to the team's effectiveness by reviewing plans… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records ... **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims. +… more
- Elara Caring (Huntley, IL)
- …at the Right Time, in the Right Place. **Job Description:** **Licensed Practical Nurse Clinical Coordinator** At Elara Caring, we care where you are and believe ... ways to make a difference as a Licensed Practical Nurse Clinical Coordinator. Being a part of something this...faxed orders, and enters into appropriate system for CTM review and approval. + Reviews, updates, and maintains the… more
- Rush University Medical Center (Chicago, IL)
- …position. Offers may vary depending on the circumstances of each case. **Summary:** The Nurse Care Manager is an Illinois licensed Registered Nurse who provides ... a diverse role as a clinician, educator, care coordinator and advocate. The Nurse is an expert in chronic disease management, prevention, health maintenance, and… more
- KPH Healthcare Services, Inc. (Hoffman Estates, IL)
- …**Job Summary:** Provides services to clients in accordance with the State Nurse Practice Act, Agency policy, and accepted professional standards of practice. The ... Registered Nurse provides nursing services utilizing a comprehensive base of...accidents and promote + Notifies supervisor of need for review and/or training related to equipment, procedures, or safety/infection… more
- Surgery Care Affiliates (Lake Villa, IL)
- …you join our team, they will. Responsibilities We are actively hiring for an Registered Nurse (RN) PreOp PACU. + Promote the mission, vision, and values of SCA . + ... to care. + Delegate tasks according to the state Nurse Practice Act (if applicable), state board of nursing...with other disciplines as needed. + Participate in quality review and performance improvement projects. + Participate in the… more
- Ascension Health (Elk Grove Village, IL)
- …transfers and bed availability and plans bed assignments accordingly. + Review all admissions and transfers for clinical/unit appropriateness and medical necessity. ... data, identify issues and potential resolutions, and prepare reports forexecutive review . **Requirements** Licensure / Certification / Registration: + Registered … more
- Molina Healthcare (Kenosha, WI)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other specific program… more
- Rush University Medical Center (Chicago, IL)
- …established research projects. 5. Submits materials (articles, media, etc.) for peer- review . 6. Presents evidence based and/or scholarly papers locally and ... disability, veteran status, and other legally protected characteristics. **Position** Registered Nurse - Clinical Care **Location** US:IL:Chicago **Req ID** 16801 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 ... including efficient utilization of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and on-site state or… more
- AbbVie (North Chicago, IL)
- …are study-related and have a major impact on regulatory compliance. Review protocols and information consent forms for scheduled studies, identify and ... communicate potential issues to the appropriate personnel. Participation in the execution of study related activities of Phase 1 clinical research studies conducted at the ACPRU. Ability to exercise discretion and confidentiality while handling sensitive… more
- US Tech Solutions (North Chicago, IL)
- …**events and manage safety reporting activities** in a timely manner. + Review protocols and informed consent forms for scheduled studies, identify, and communicate ... potential issues to the appropriate personnel. + Participate in nursing study related activities as required by protocol in compliance with corporate, divisional, and depart-mental SOP not タルs and external (CFR, ICH, GCP) regulatory guidelines. + Communicate… 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 ... to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services. + Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical and… more
- Adecco US, Inc. (Chicago, IL)
- …outcomes. + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines ... approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services + Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies,… more
- Wolters Kluwer (Riverwoods, IL)
- …Mentor, review , and edit customized projects. + Serve as the final reviewer for test writing, curriculum development, program review reports, and other ... curricular success. If you are an analytical thinker with a passion for developing nurse educators, we want to hear from you! You will collaborate closely with the… more
- Molina Healthcare (Chicago, IL)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... hire. + MCO experience preferred. + UM experience preferred- prior auth, inpatient review , concurrent review and prior experience wtih InterQual or MCG… more