NewRN Care Manager Weekend Endeavor HealthRN Care Manager WeekendEvanston, ILOur 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. Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties.
RN Care Manager - Care Coordination Endeavor HealthRN Care Manager - Care CoordinationArlington Heights, ILOur 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. Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties.
NewRN Manager - Perioperative Services (Evenings) Carle HealthRN Manager - Perioperative Services (Evenings)Urbana, ILThe RN Manager, Perioperative Services - Evenings has leadership accountability for planning, facilitating and monitoring the evening activities and functions of the Operating Room, Pre-Op, PACU, and Sterile Processing Departments. 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.
LPN / Clinical Support Specialist, Home Health AccentCare, Inc.LPN / Clinical Support Specialist, Home HealthRosemont, IL$60,000–$65,000Daily 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.
NewTravel Procedural IR RN - $3,800 per week Prime StaffingTravel Procedural IR RN - $3,800 per weekUrbana, ILPreferred Skills & Experience: -N/A Required Skills: [ "NURSING", "PATIENT CARE", "MODERATE SEDATION MANAGEMENT", "HEMODYNAMIC MONITORING", "PROCEDURE DOCUMENTATION"] Additional Skills: [ "USE OF SUPPLIES AND EQUIPMENT IN PROCEDURES"]Education: Required Education: -ASN.Preferred Education: -BSN.Required Certifications & Licensure: -Illinois state RN License in good standing.-BLS ID: 64206754 Shift: Day M-F: 730am-5pm 5x8 Hr Description: Job Description: 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.
NewRN - Wound Center Hospital Consult (Weekend) Carle HealthRN - Wound Center Hospital Consult (Weekend)Urbana, IL$33.11–$53.88 / hourCertifications: 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.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNMacomb, IL$79,450–$102,154 / yearAs 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.
NewRN - HVI Electrophysiology Lab Carle HealthRN - HVI Electrophysiology LabUrbana, ILCertifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR); Advanced Cardiac Life Support (ACLS) within 1 year - American Heart Association (AHA); Basic Life Support (BLS) within 30 days - American Heart Association (AHA), Education: College Diploma: Nursing (Required), Work Experience: Responsibilities. 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.
RN - Surgical T7 Carle HealthRN - Surgical T7Urbana, IL$38.93–$63.35 / hourThe 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.
RN - Orthopedics (Inpatient) Carle HealthRN - Orthopedics (Inpatient)Urbana, IL$38.93–$63.35 / hourAssess 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.
RN - Emergency Department (Richland) Carle HealthRN - Emergency Department (Richland)Olney, IL$36.80–$59.89 / hourCertifications: 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.
Nursing - Infection Control RN Yale New Haven HealthNursing - Infection Control RNLincoln Park, RICertified Registered Nurse Anesthetist Completion of Certified Nurse Anesthetist Training Program Graduate of a Nurse Anesthesia Educational Program accredited by the American Association of Nurse Anesthetist Council on accreditation of Nurse Anesthesia Programs. Certified Registered Nurse Anesthetist AANA Certification, State of CT RN and APRN License, ACLS DEA Registration and State of CT Controlled Substance Registration CRNA's must have sharp concentration and focus, along with the ability to stay calm under stressful conditions.
NewTravel Nurse RN - Emergency Room (ER) / Trauma - $2,182 per week in Rockford, IL TravelNurseSourceTravel Nurse RN - Emergency Room (ER) / Trauma - $2,182 per week in Rockford, ILRockford, IL$2,182Job Title: Emergency Room Nurse Profession: Nursing Specialty: Emergency Room Nurse Duration: 13 weeks Shift: Night Shift Hours per Shift: 12 hours (7:00 PM - 7:30 AM) Experience: Minimum of 2 years License: Active IL RN Licensure Certifications: BLS, ACLS, PALS, NIHSS, TNCC or TNS Must-Have: - Graduate of an accredited nursing program - Education verification required Description: We are looking for an experienced ER RN for this position. You will develop, initiate, and execute individualized patient plans of care as prescribed by the physician, including patient and family instruction.
NewAssociate Medical Device Sales Representative Medical Sales CollegeAssociate Medical Device Sales RepresentativeJoliet, ILMuch like the specialized technical certifications and self-funded training tracks required to enter fields like veterinary technology or nursing, this program requires a personal tuition investment from the candidate (with financing options and flexible payment plans available for qualified applicants). Pathway Requirement: Successful completion of the required Medical Sales College program (such as TotalOrtho, TotalOrtho+, or specialized diagnostic/orthopedic tracks) serves as the prerequisite industry baseline for candidates lacking direct field experience.
NewSubstance Use Disorder Counselor - Outpatient Substance Use - Peoria Carle HealthSubstance Use Disorder Counselor - Outpatient Substance Use - PeoriaPeoria, ILClinical Excellence/Patient Care 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.
NewSubstance Use Disorder Counselor - Medication Assisted Recovery Carle HealthSubstance Use Disorder Counselor - Medication Assisted RecoveryPeoria, ILClinical Excellence/Patient Care Provides evaluation, counseling and therapeutic services to chemically dependent patients/families assessing patient’s social, psychological, emotional, financial, cultural problems and chemical abuse history. Bachelor's Degree in in Social Work required within two (2) years if incumbent has or plans to pursue a LSW license and has met/will meet the three (3) years of supervised professional experience or Master's Degree in related field.
NewUtilization Management Nurse Consultant Integrated Resources, IncUtilization Management Nurse ConsultantDowners Grove, IllinoisContractorJob DescriptionJob Title: Utilization Management Nurse ConsultantDuration: 6 months (Possible extension)Location: Downers Grove, ILResponsibilities:Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months).The ability to create and process clinical for Behavioural Health cases on a live phone queue, create and process clinical to of a determination to the provider.
NewUtilization Management Nurse Integrated Resources, IncUtilization Management NurseDowners Grove, IllinoisContractorJob DescriptionJob Title: Utilization Management Nurse ConsultantDuration: 6 months (Possible ext)Location: Downers Grove, ILResponsibilities:· Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.· Additional Information (situational competencies, skills, work location requirements, etc.)· Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding· Effective communication skills, both verbal and written.·
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantIL$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. 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.
Utilization Management Registered Nurse (RN) - Remote GuidehealthUtilization Management Registered Nurse (RN) - RemoteChicago, ILRemote$70,000–$75,000 / yearDriven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.
NewUtilization Management and Population Health Nurse Humboldt Park HealthUtilization Management and Population Health NurseChicago, ILRefer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management. Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions.
NewUtilization Management Nurse Advocate Aurora Health IncUtilization Management NurseOak Brook, IL$35.50–$53.25 / hourWorks closely with medical staff, hospital departments and ancillary services as part of Outcome Facilitation Team/Multidisciplinary Team in expediting care delivery to avoid delays in timely service provision and implementing and reporting utilization management (UM) activities, as applicable. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise.
Utilization Management and Population Health Nurse Humboldt Park Health CareersUtilization Management and Population Health NurseChicago, IllinoisRefer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management. Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions.
UTILIZATION REVIEW NURSE-ED (TR/PRN) NIGHTS Riverside HealthcareUTILIZATION REVIEW NURSE-ED (TR/PRN) NIGHTSKANKAKEE, Illinois$41.31–$55.28 / hourThis position involves reviewing patient cases, assessing the necessity of admissions and continued stays, and collaborating with healthcare providers to enhance patient outcomes and hospital efficiency by managing documentation and optimizing resource utilization. Case Review and Assessment: Conduct thorough reviews of patient cases in the Emergency Department to assess the necessity and appropriateness of admissions, continued stays, and level of care.
UTILIZATION REVIEW NURSE-ED (PT NIGHTS) Riverside HealthcareUTILIZATION REVIEW NURSE-ED (PT NIGHTS)KANKAKEE, Illinois$41.31–$55.28 / hourThis position involves reviewing patient cases, assessing the necessity of admissions and continued stays, and collaborating with healthcare providers to enhance patient outcomes and hospital efficiency by managing documentation and optimizing resource utilization. Case Review and Assessment: Conduct thorough reviews of patient cases in the Emergency Department to assess the necessity and appropriateness of admissions, continued stays, and level of care.
UTILIZATION REVIEW NURSE-ED (TR/PRN) DAYS Riverside HealthcareUTILIZATION REVIEW NURSE-ED (TR/PRN) DAYSKANKAKEE, Illinois$41.31–$55.28 / hourThis position involves reviewing patient cases, assessing the necessity of admissions and continued stays, and collaborating with healthcare providers to enhance patient outcomes and hospital efficiency by managing documentation and optimizing resource utilization. Case Review and Assessment: Conduct thorough reviews of patient cases in the Emergency Department to assess the necessity and appropriateness of admissions, continued stays, and level of care.
Utilization Review RN (Onsite) Memorial HealthUtilization Review RN (Onsite)Springfield, IllinoisFull timeFacilitates 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.
NewUtilization Review RN (Onsite) Taylorville Memorial HospitalUtilization Review RN (Onsite)Springfield, ILFacilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required.
NewUtilization Management Clinical Consultant Integrated Resources, IncUtilization Management Clinical ConsultantDowners Grove, IllinoisFull timeRN or LCSW only) Job description: Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. IT Life Sciences Allied Healthcare CRO Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
RN Utilization Review Case Manager Gateway Regional Medical CenterRN Utilization Review Case ManagerGranite City, IL$32–$48 / hourFull timeThe Utilization Review Specialist RN assumes responsibility and accountability for admission and concurrent reviews to ensure the prevention of denials from all payers, as well as coordination and management of appeals for accounts deemed appropriate for appeal. The Specialist works collaboratively with interdisciplinary teams to identify denial trends, improve workflows, and ensure timely resolution of utilization review and appeals processes.
Utilization Review Nurse Silver Cross HospitalUtilization Review NurseNew Lenox, IL$34.73–$45.15 / hourThe final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more. Position Summary: Performs medical record review for severity of illness and intensity of service; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement; identifies variance from established pathways.
Utilization Management Behavioral Health Professional Humana IncUtilization Management Behavioral Health ProfessionalILRemote$65,000–$88,600 / yearWork at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Humana Healthy Horizons in Kentucky is looking for a Utilization Management Behavioral Health Professional 2 who uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
UTILIZATION MANAGEMENT ANALYST Sinai Health System IncUTILIZATION MANAGEMENT ANALYSTChicago, ILThe role includes but is not limited to, clinical submission to the payers, securing an authorization for the visit type, continuous follow up with payers for authorizations and/or additional information, and basic reporting for payer specific behaviors. Job Description: This position provides monitoring of inpatient and outpatient accounts to ensure accuracy of submissions and proper authorizations are obtained in order to secure reimbursement.
Utilization Review Clinician (RN) - Must reside in IL Molina Healthcare IncUtilization Review Clinician (RN) - Must reside in ILChicago, ILResponsible 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.
Case Manager/Utilization Review Saint Anthony HospitalCase Manager/Utilization ReviewChicago, ILFlexible with a working knowledge of Excel, Word and preferably InterQual criteria Basic Life Support Benefits Comprehensive Health Insurance Plans (Medical, Dental, Vision) Coverage begins on new hires first day Employer matching retirement plans Eligibility for the Public Service Loan Forgiveness (PSLF) Program Free parking Saint Anthony Hospital Highlights Community Hospital with Modern Technology: Work in an environment that blends advanced tools with a missionâ€'driven, communityâ€'focused approach. Final offers are based on various factors, including skill set, experience, location, qualifications and comparisons to colleagues in similar roles About Us: Saint Anthony Hospital is a mission-driven, community-focused organization where your career can thrive while making a meaningful impact on the health and wellness of families in our neighborhood.
RN Clinical Transitions Specialist - Inpatient Case Management - Methodist Carle HealthRN Clinical Transitions Specialist - Inpatient Case Management - MethodistPeoria, Illinois$35.87–$58.37 / hourParticipates 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.
Ed Utilization Review/Case Manager InsightEd Utilization Review/Case ManagerChicago, IllinoisInteracts regularly with physicians and other members of the health team to obtain information about the course of care; provides information in return regarding potential denial of reimbursement or inappropriate level of care: Refers cases not meeting criteria in a timely manner to the physician advisor. General Summary : The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and provides assistance with discharge needs in a timely fashion.
NewDIR - UTILIZATION REVIEW / MGMT University Health Services IncDIR - UTILIZATION REVIEW / MGMTSPRINGFIELD, ILOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.
RN Clinical Transitions Specialist - Inpatient Case Management (Methodist) Carle Foundation HospitalRN Clinical Transitions Specialist - Inpatient Case Management (Methodist)Peoria, IL$34.01–$58.50 / hourEnsures 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. • Coordinates the transition from inpatient care to post-hospital care, collaborating with physicians, consultants, internal and external referrals to facilitate appropriate next level of care to meet patient goals and outcomes.
Utilization Review/Reimbursement Specialist Sinai Health System IncUtilization Review/Reimbursement SpecialistChicago, ILThis role reviews medical records to determine the medical necessity and appropriateness of post-acute care services, secures insurance authorizations, conducts extended stay reviews, and supports patient access to inpatient rehabilitation services. The specialist works collaboratively across the Sinai Chicago network to manage denial prevention and appeals, ensure timely payer approvals, optimize reimbursement, and promote access to the appropriate level of care.
Utilization Review Coordinator University Health Services IncUtilization Review CoordinatorChampaign, ILOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.
NewRN Care Management (Full-time) Humboldt Park HealthRN Care Management (Full-time)Chicago, ILPart timeensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care He/she clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services through effective care coordination and utilization of healthcare resources in order to achieve desired clinical and financial goals. Key responsibilities include determination of medical necessity, ability to partner with the healthcare team to ensure all aspects of the patient’s needs, clinical, psychosocial and financial are adequately addressed in the transition of care plan and to manage the patient’s timely progression of care and safe transition to the next most appropriate level of care.
Utilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerChicago, ILRemoteFull timeApplies 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.
Medical Management Nurse Elevance Health IncMedical Management NurseSpringfield, IL$75,772–$113,658 / yearHow 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.
Utilization Reviewer-Full Time On-Site Northwestern Memorial HealthCareUtilization Reviewer-Full Time On-SiteDeKalb, ILCommunicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status, including making precertification or notice of admission calls on patients directly to minimize financial risk to patient and facility. Understands health care benefit plan provisions and managed care contracting, and communicates benefits and approval status of patients to clinical staff and physicians, and to patients and family members when needed.
Customer Success & Clinical Utilization Manager... US Headquarters, Chicago · Fully Remote Mentice ABCustomer Success & Clinical Utilization Manager... US Headquarters, Chicago · Fully RemoteChicago, ILRemoteIn this role, you will partner closely with healthcare providers to drive adoption, utilization, and measurable impact of simulation-based training solutions across clinical environments. You will act as a trusted clinical advisor to customers, ensuring our solutions meet real-world needs while helping demonstrate clinical, operational, and financial value.
NewRN Care Management (Full-time) Humboldt Park Health CareersRN Care Management (Full-time)Chicago, Illinoisensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care He/she clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services through effective care coordination and utilization of healthcare resources in order to achieve desired clinical and financial goals. Key responsibilities include determination of medical necessity, ability to partner with the healthcare team to ensure all aspects of the patient’s needs, clinical, psychosocial and financial are adequately addressed in the transition of care plan and to manage the patient’s timely progression of care and safe transition to the next most appropriate level of care.
Remote Care Management Nurse Cambia Health Solutions IncRemote Care Management NurseOregon, ORRemote$36.80–$49.80 / hourAs a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.