- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization management ... rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse 2 ensures...make an impact** **Required Qualifications** + Active unrestricted Licensed Registered Nurse , ( RN ), in your… more
- Trinity Health (Maywood, IL)
- …preauthorization requests utilizing defined criteria. Collects, analyzes and communicates relevant utilization management information to insurers and third party ... IPA or MCO. Leadership experience is preferred. **Licensure/Certifications:** **Required:** Current Registered Nurse License State of Illinois **Our Commitment… more
- Centene Corporation (Springfield, IL)
- …LPC, or a PhD, PsyD or RN . 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working ... staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral...a LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD or RN license in applicable state. **For Illinois YouthCare plan… more
- Sharecare, Inc. (Springfield, IL)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... with the participants and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by an Operations… more
- Carle (Urbana, IL)
- …REQUIREMENTS Associate's Degree in or diploma in nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License Licensed and ... RN - Clinical Admission Specialist + Department: Transfer Coordination...EMTALA guidelines). Actively collaborates with providers, nursing, and case management / utilization management to ensure appropriate… more
- Trinity Health (Maywood, IL)
- …Case manage patients with complex, chronic medical and psychosocial issues. Perform utilization management strategies for those cases managed using the lightest ... knowledge, skills and abilities to their fullest! You will be providing care management and coordination in the ambulatory setting. As part of an interdisciplinary… more
- CVS Health (Springfield, IL)
- …Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, ... implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member… more
- Centene Corporation (Burr Ridge, IL)
- …operations. 5+ years of leadership experience. Master's degree preferred. **License/Certification:** Registered Nurse . Certified Case Management (CCM). **For ... only:** This position shall be a licensed Physician, licensed registered nurse , or other professional as approved... Management and Care Coordination activities and monitor utilization of Enrollees' physical health and behavioral … more
- Elevance Health (Chicago, IL)
- **Telephonic Nurse Disease Management II** **$2000 Sign on Bonus** At **Federal Health Products and Services - FHPS** , a proud member of the Elevance Health, ... pm, or 2:30 pm - 11 pm EST.** The **Telephonic** **N** **urse Disease Management II** will be responsible for telephonic outreach, enrollment, and management of… more