- ProgenyHealth (Elk Grove Village, IL)
- ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization , ... attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for...events throughout the year + Role specific - full remote work week ProgenyHealth positively recruits people from diverse… more
- CVS Health (Springfield, IL)
- …personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+ years of… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our hospital ... you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic computer skills… more
- Humana (Springfield, IL)
- …us put health first** Full-Time Remote , Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health ... of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from medical… more
- Humana (Springfield, IL)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge… more
- Rush University Medical Center (Chicago, IL)
- …implement solutions for current situations. The Ambulatory RN 2 is a competent nurse who has mastered technical skills and utilizes evidence based interventions. The ... **Other information:** **Required Job Qualifications:** * Current State of Illinois Registered Nurse licensure. State of IN RN licensure required for those working… more
- Humana (Springfield, IL)
- …Training programs may include, but not be limited to, Pre-Certification, Care Management , Utilization Management , and/or Compliance. + Plans, coordinates, ... without restrictions -or- compact state license. + Over 1 year of Utilization Management (prior authorization) experience working in managed care… more
- Marriott (Springfield, IL)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Nurse CARE Manager coordinates timely, ... **Additional Information** Nurse CARE Manager (CARE - Coordinated Action and...Claims Services + Collaborate with Claims department regarding case management . + Collaborate with UNM on utilization … more
- Elevance Health (Chicago, IL)
- …managers who will perform clinical reviews for a set of Post Acute Care Utilization Management solutions and complex cases such as home health, wound care, ... Acute Care UM** + Job Family: MED > Licensed Nurse + Type: Full time + Date Posted:Apr 16,...management experience required. Preferred: -Leadership experience in a utilization management clinical operations business inside a… more
- Humana (Springfield, IL)
- …+ Comprehensive knowledge of Power BI, QikBase, QikView (QV) + Knowledge of Medicaid Utilization Management + Certified Nurse Assistant or Medical Assistant ... notice of adverse benefit determination and approval letters for Medicaid Utilization Management (UM) authorization determinations in compliance with… more
- Abbott (Chicago, IL)
- …to support diagnostic testing which provides important information for treatment and management of diseases and other conditions. We currently have an opportunity ... for a **Technical Consultant** . This is a remote , field-based position located in the **Chicago, IL.** This position will assist Account Managers with evaluations,… more
- Lincoln Financial Group (Springfield, IL)
- …in a behavioral health setting including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health ... to our Clinical Organization to work in one of our key city locations or Remote Based office. As a Behavioral Health Consultant, you will be part of a growing… more
- Centene Corporation (Burr Ridge, IL)
- …5+ years of leadership experience. Master's degree preferred. **License/Certification:** Registered Nurse . Certified Case Management (CCM). **For Illinois Plan ... Must reside in Illinois. Will direct all activities pertaining to Case Management and Care Coordination activities and monitor utilization of Enrollees'… more
- Veterans Affairs, Veterans Health Administration (Peoria, IL)
- …appropriate. Duties and responsibilities include a variety of medical care management techniques, which requires knowledge, skills, licensures, and experience as a ... adequate and comprehensive services and communicates these to staff physicians, nurse practitioners, physician assistants and other members of Ambulator Care.… more