306 Results for

Utilization Management Nurse Jobs in Illinois

Jobs

Peoria, IL

Participates in multidisciplinary rounds and initiates timely referrals to other internal healthcare team members (quality improvement, risk manager, social workers, pharmacy, therapy services, etc.) Performs case management activities of assessment, coordination, planning, monitoring, implementation, and evaluation. Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely transition from the acute care/hospital setting to an appropriate level of care outside the hospital.

9 days ago

Urbana, IL

Certifications: Accredited Case Manager (ACM) within 3 years - American Case Management Association (ACMA); Basic Life Support (BLS) within 30 days - American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: College Diploma: Nursing, Work Experience: Responsibilities . Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely transition from the acute care/hospital setting to an appropriate level of care outside the hospital.

9 days ago

Peoria, IL

Certifications: Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor's Degree: Nursing (Required), Work Experience: Specific to patient population . Ensure desired level of Productivity is achieved through appropriate staffing levels, monitor for correct clocking practices, and ensuring that specialty Lead RN’s are held accountable for their employees accomplishing their assigned duties.

9 days ago

Glenview, IL

Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. Daily functions may include admission review and continued stay reviews, contacting insurance companies to provide clinical information to support admissions/continued hospital stays, referring cases to the Physician Advisor for further review, collecting QA and Avoidable Days data as directed.

8 days ago

Galesburg, IL

$92,876–$181,108 / year

Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. See Molina Healthcare Privacy Policy at https://www.molinahealthcare.com/members/common/en-US/Pages/terms_privacy.aspx? and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.

Today

Carbondale, IL

$92,876–$181,108 / year

JOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. See Molina Healthcare Privacy Policy at https://www.molinahealthcare.com/members/common/en-US/Pages/terms_privacy.aspx? and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.

Today

Quincy, IL

$92,876–$181,108 / year

Today

Urbana, IL

Certifications: Accredited Case Manager (ACM) within 3 years - American Case Management Association (ACMA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: Nursing, Work Experience: Act as a liaison working with patient/family and physician to determine next level of careConducts case review presentations to educate peers on unique or challenging cases and scope of practice issues. Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely transition from the acute care/hospital setting to an appropriate level of care outside the hospital.

9 days ago

Urbana, IL

9 days ago

Macomb, IL

$79,450–$102,154 / year

As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support.

8 days ago

Peoria, IL

Maintains active communication among medical staff, interdepartmental staff, and operating room staff; Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor's Degree: Nursing (Required), Work Experience: Specific to patient population Coordinates and supervises the operation of the daily surgery schedule, case assignment, room and personnel assignments. Ensure desired level of Productivity is achieved through appropriate staffing levels, monitor for correct clocking practices, and ensuring that specialty Lead RN’s are held accountable for their employees accomplishing their assigned duties.

9 days ago

Peoria, IL

Certifications: Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor‘s Degree: Nursing (Required), Work Experience: Specific to patient population Responsibilities . Ensure desired level of Productivity is achieved through appropriate staffing levels, monitor for correct clocking practices, and ensuring that specialty Lead RN’s are held accountable for their employees accomplishing their assigned duties.

9 days ago

Urbana, IL

$38.93–$63.35 / hour

The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of patients for a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources within the philosophy of the institution. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.

14 days ago

Urbana, IL

$38.93–$63.35 / hour

Assess ortho and medical/surgical patients every shift Educate ortho and medical/surgical patients on wound care, proper mobility, self-care, medication management, care transition needs and any additional patient specific needs Coordinate with physician and surgeon partners on the care of ortho and medical/surgical patients Delegate and monitor interventions of the HCT staff Set up ortho traction and manipulate surgical traction devices for mobility and wound care Manage wound appliances such as wound vacs, drains, pouches and other urological devices . Frequent nursing skills/equipment used: Wound Vacs, JP drains, Buck’s tractions, external fixators, lift equipment, orthotic devices (boots, slings, walker, etc), chest tubes, Foley/IV/Mediport insertions, Central line care and lab draws, Nursing prioritization, IV pumps, PCA pumps, Feeding pumps, SCDs, Telemetry monitoring, Patient connection.

11 days ago

Rosemont, IL

$60,000–$65,000

Daily completion of the following tasks: daily management of KPIs, field staff support, verbal orders, workflow, escalation/complaint calls, updating clinical information, and field visits as required. Reporting and management of patient episodes that are at risk for LUPA status – including recognition of risk, understanding missed visit concerns, coordinating with clinicians/patients/schedulers as needed, etc.

6 days ago

Tremont, NY

This specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy, immunotherapy, and targeted therapies, and surgical oncology patients, who are in various stages of their surgical journey, including pre-operative evaluation, post-operative care, and follow-up. Additional Information Smilow Ambulatory Multispecialty Department YSC (NP 1, NP4, NP8) This department is rooted in oncology nursing excellence and serves as a hub for patients undergoing cancer treatment and management for solid tumor cancers.

7 days ago

Urbana, IL

Certifications: Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: College Diploma: Nursing, Work Experience: Responsibilities . Overview The staff RN is a professional caregiver who assumes responsibility for a group of patients for a designated timeframe and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial, and human resources within the philosophy of the institution.

9 days ago

Urbana, IL

5,000 Sign On Bonus RN Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Nursing, Work Experience: Communicates with others directly and in private when necessary to resolve issues. The staff RN is a professional caregiver who assumes responsibility for a group of patients for a designated timeframe and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial, and human resources within the philosophy of the institution.

9 days ago

Urbana, IL

$33.11–$53.88 / hour

Certifications: Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: College Diploma: Nursing, Work Experience: RN>1yr. The staff RN is a professional caregiver who assumes responsibility for a group of patients for a designated timeframe and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial, and human resources within the philosophy of the institution.

8 days ago

Olney, IL

$36.80–$59.89 / hour

Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR); Pediatric Advanced Life Support (PALS) within 1 year - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Advanced Cardiac Life Support (ACLS) within 1 year - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), Education: College Diploma Nursing, Work Experience: Responsibilities. Exhibits proficiency of setting up, assisting physician, and cleaning equipment with procedures (Airway maintenance, Central lines, Chest tubes, GYN/OB procedures, Lumbar puncture, Orthopedic procedures, Sexual assault, Suturing, Thoracentesis, Poisoning, etc.).Performs hourly rounding on the Emergency Department patients.

8 days ago

Champaign, IL

$33.11–$53.88 / hour

Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR); Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA), Education: College Diploma: Nursing; Bachelor's Degree: Nursing, Work Experience: 2+yrs Nursing. Psycho-social support ▪ Identify complex behavioral or social needs; make appropriate referrals (SW, BH consultants, and community agencies/partners) through collaboration with physician (hospitalists/PCPs/specialists), leads and coordinates activities of interdisciplinary treatment team to evaluate progress, identify barriers, and opportunities to improve care.

8 days ago

Urbana, IL

9 days ago

Urbana, IL

$35.87–$58.37 / hour

The HVI offers several unique opportunities for personal and professional growth, flexible staffing options (i.e. cross-training, job sharing, minimal on-call shifts), HVI MD Lecture series (which includes free CEUs for staff), mentoring program (to support new hires and transfers), and educational events with various HVI equipment and procedural training (i.e. Shockwave, CoroFlow, Structural Heart Program). The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of patients for a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources within the philosophy of the institution.

8 days ago

Normal, IL

$36.80–$59.89 / hour

Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR); Advanced Cardiac Life Support (ACLS) within 1 year - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA); Basic Life Support (BLS) within 30 days - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), Education: H.S. The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of patients for a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources within the philosophy of the institution.

8 days ago

Normal, IL

Certifications: Certified Lactation Specialist (CLS) - Lactation Education Consultants (LEC); International Board Certified Lactation Consultants (IBCLC) within 2 years - International Board of Lactation Consultant Examiners (IBCLE); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR); Basic Life Support (BLS) within 30 days - American Heart Association (AHA); National Nursing Certification - Varies; Certified Lactation Counselor (CLC) - Academy of Lactation Policy and Practice (ALPP), Education: College Diploma: Nursing (Required), Work Experience: Mother/baby . Overview The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of patients for a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources within the philosophy of the institution.

9 days ago

Urbana, IL

9 days ago

Wadsworth, IL

The primary responsibility of the MDS Nurse is to organize, complete and evaluate resident assessment and plan of care in accordance with current applicable state, federal guidelines/ regulations and as may be directed by the Director of Nursing to ensure each resident is encouraged to attain the highest possible level of functioning. The ability to anticipate needs of residents/clients and co-workers in a pro-active fashion seeking to meet those needs even before a formal request is made.

7 days ago

Normal, IL

9 days ago

Urbana, IL

The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of patients for a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources within the philosophy of the institution. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model.

9 days ago

Crestwood, IL

$86,000–$100,000

Performs integrated IDT functions encompassing the Occupational Therapist role and the Home Care Coordinator role, ensuring cohesive planning, communication, and oversight of both rehabilitative and home-based support services for PACE participants. Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. .

6 days ago

Urbana, IL

Certifications: Licensed Pharmacist - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Doctorate: Pharmacy; Experience In Lieu of Education, Work Experience: Pharmacy . At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.

9 days ago

Peoria, IL

$19.62–$31.78 / hour

Clinical Excellence/Patient CareProvides evaluation, counseling and therapeutic services to chemically dependent patients/families assessing patient’s social, psychological, emotional, financial, cultural problems and chemical abuse history. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.

8 days ago

Normal, IL

$23.36–$39.01 / hour

8 days ago

Urbana, IL

Certifications: Licensed Pharmacist within 3 months - Varies; Licensed Pharmacist - Illinois Department of Financial and Professional Regulation (IDFPR), Education: Experience In Lieu of Education; Doctorate: Pharmacy, Work Experience: Pharmacy . At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.

9 days ago

Normal, IL

Provides evaluation, counseling and therapeutic services to chemically dependent patients/families assessing patient’s social, psychological, emotional, financial, cultural problems and chemical abuse history. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.

9 days ago

Eureka, IL

Acts a liasion working with patient/family and physician to determine next level of care and manage LOSCoordinates transitions to appropriate levels of care (ie acute to subacute, swing bed to home, acute to home etc) collaborating with physicians, consultants, internal and external referrals to facilitate appropriate level of care to meet patient goals and outcomes. Qualifications Certifications: National Nursing Certification within 3 years - Varies; Basic Life Support (BLS) within 30 days - American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor's Degree: Nursing, Work Experience: Nursing RN>2yrs Case management Preferred .

9 days ago

URBANA, Illinois

$34.25–$51.13 / hour

OSF HealthCare is dedicated to provide Mission Partners with a comprehensive and market-competitive total rewards package that includes benefits, compensation, recognition and well-being offerings that focus on the whole person and engage with their current stage of life and career. Overview: POSITION SUMMARY: The Utilization Management and Review Specialist (UMR Specialist) evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient.

1 day ago

Work At Home, IL

$29.10–$62.32 / hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

4 days ago

Springfield, Illinois

Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required.

30+ days ago

Downers Grove, Illinois

$125,000–$188,000 / year

This leader bridges internal operations, payer relationships, and delegated vendors to ensure high-quality, cost-effective care delivery while minimizing regulatory and operational risk. The compensation for this role includes a base pay range of $125K-188K, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity.

30+ days ago

Chicago, IL

Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.

18 days ago

Peoria, Illinois

$35.87–$58.37 / hour

14 days ago

Urbana, Illinois

$35.87–$58.37 / hour

Qualifications: Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR); Accredited Case Manager (ACM) within 3 years - American Case Management Association (ACMA); Basic Life Support (BLS) within 30 days - American Heart Association (AHA), Education: College Diploma: Nursing (Required), Work Experience: None. Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely transition from the acute care/hospital setting to an appropriate level of care outside the hospital.

30+ days ago

Chicago, IL

Remote

Full time

Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.

30+ days ago

Springfield, IL

$75,772–$113,658 / year

How you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.

30+ days ago

Chicago, IL

In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.

18 days ago

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Utilization Management Nurse Jobs in Illinois

RN - Clinical Transitions Specialist Carle Health

RN - Clinical Transition Specialist Carle Health

RN - Surgery Coordinator (Methodist) Carle Health

RN Care Manager-Nights Endeavor Health

Field Nurse Practitioner (Galesburg, IL) Molina Healthcare

Field Nurse Practitioner (Carbondale, IL) Molina Healthcare

Field Nurse Practitioner (Quincy, IL Molina Healthcare

Clinical Transition Specialist RN Weekend - CFH Carle Health

Health Care Specialist, RN Carle Health

Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical Care

RN Nursing Coordinator - Surgery Carle Health

RN Surgery Coordinator - CMH Surgery Carle Health

RN - Surgical T7 Carle Health

RN - Orthopedics (Inpatient) Carle Health

LPN / Clinical Support Specialist, Home Health AccentCare, Inc.

Medical-Surgical Registered Nurse (Med-Surg RN) Yale New Haven Health

RN - Wound Ctr Inpatient Consultant Carle Health

Nurse Medical Consultant Carle Health

RN - Wound Center Hospital Consult (Weekend) Carle Health

RN - Emergency Department Carle Health

RN Care Coordinator Carle Health

Care of - laboratory nurse Carle Health

RN - Cath Lab Carle Health

RN - Cardiovascular Care Unit (Intermediate) Carle Health

Lactation Consultant RN - Mother/Baby Carle Health

RN - Wound Ctr Inpatient Consultant (Weekend) Carle Health

MDS Registered Nurse (RN) - PRN Franciscan Ministries

Registered Nurse (RN)- Medical Nursing Unit Carle Health

Registered Nurse Full time - Home Health - $, Sign On Bonus Carle Health

Occupational Therapist BoldAge PACE

Clinical Staff Pharmacist - Medical Reconciliation Carle Health

Substance Use Disorder Counselor - Outpatient Substance Use - Peoria Carle Health

Counselor (CADC) - Chemical Dependency - BroMenn Carle Health

Pharmacist - Inpatient, Medical Reconciliation Carle Health

Counselor (CADC) - Chemical Dependency Carle Health

Admissions Coordinator RN/UM Carle Health

RN Utilization Management & Review Specialist OSF HealthCare

Utilization Management Nurse Consultant CVS Health Corp

Utilization Review RN Memorial Health

Director, Utilization Management Duly Health and Care

Utilization Review Clinician (RN) - Must reside in IL Molina Healthcare Inc

RN Clinical Transitions Specialist - Inpatient Case Management - Methodist Carle Health

RN Clinical Transitions Specialist - Inpatient Case Management (Weekend) Carle Health

Utilization Clinical Reviewer TriWest Healthcare Alliance

Medical Management Nurse Elevance Health Inc

Behavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield Association

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