NewTravel Nurse RN - Intensive Care Unit (ICU) / Critical Care in Maywood, IL TravelNurseSourceTravel Nurse RN - Intensive Care Unit (ICU) / Critical Care in Maywood, ILMaywood, ILTravelNurseSource is working with Concentric Healthcare Staffing to find a qualified ICU/Critical Care RN in Maywood, Illinois, 60153! Key Responsibilities Provide direct patient care in a Medical Intensive Care Unit (MICU) setting.
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 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.
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.
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 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 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.
Care Review Clinician (RN) - (IL Nursing license) Molina Healthcare IncCare Review Clinician (RN) - (IL Nursing license)Chicago, ILRemoteResponsible 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.
NewCare Review Clinician (RN) - (IL Nursing License) Molina Healthcare IncCare Review Clinician (RN) - (IL Nursing License)Chicago, ILRemoteResponsible 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.
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.
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.
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.
Nurse Auditor - Medical Bill Review (Remote) Rising Medical SolutionsNurse Auditor - Medical Bill Review (Remote)Chicago, ILRemoteJoin our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
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 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.
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.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadChicago, ILRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
Registered Nurse - Post Acute Network Skilled Nursing Facility Program Manager IL Advocate Aurora Health IncRegistered Nurse - Post Acute Network Skilled Nursing Facility Program Manager ILLibertyville, IL$41.10–$61.65 / hourOur Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs * Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Department: 08690 Post Acute Care - Skilled Nursing Facility Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Candidate must have IL RN license REGISTERED NURSE POST ACUTE NETWORK SKILLED NURSING FACILITY PROGRAM MANAGER LOCATION: NORTHEAST REGION WITH FOCUS AROUND CONDELL HOSPITAL AND GOOD SHEPHERD HOSPITAL AND SURROUNDING SKILLED NURSING FACILITIES HOURS: DAYS M-F, NO HOLIDAYS, NO WEEKENDS, NO ON CALL Pay Range $41.10 - $61.65 Major Responsibilities: Serves as the liaison between the hospital and the post acute network (PAN) skilled nursing facilities.
Charge Registered Nurse - OR Days Advocate Aurora Health IncCharge Registered Nurse - OR DaysPark Ridge, IL$41.10–$61.65 / hourPhysical Requirements and Working Conditions: • Ability to work within a rapid changing environment • Ability to work collaboratively with internal/external customers • May be exposed to hazardous materials and life-threatening diseases • Ability to demonstrate a commitment to patient-focused care • Ability to prioritize independently and respond to multiple simultaneous requests • Ability to work under stressful conditions and in difficult situations • Ability to perform lifting/transfer activities related to patients (up to 50 lbs. Knowledge, Skills & Abilities Required: • Strong clinical skills • Ability to communicate effectively and work cohesively with a diverse work group • Utilization of critical thinking in timely decision making • Current RN licensure in Illinois • CNOR preferred • Demonstrated leadership experience.
CASE MANAGER Registered Nurse PRN Methodist Hospitals IncCASE MANAGER Registered Nurse PRNMerrillville, INAbility to assess and interpret data about the patients status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.
Registered Nurse-Clinical Lead InsightRegistered Nurse-Clinical LeadChicago, IllinoisPractices within the scope of the Illinois Nurse Practice Act to ensure the delivery of comprehensive, high quality, individualized nursing care, based upon knowledge, experience and critical thinking skills. Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of functions, tasks, duties, responsibilities and requirements of employees so classified.
Registered Nurse (RN) Clinical Operation Resource Advocate Aurora Health IncRegistered Nurse (RN) Clinical Operation ResourceLake Zurich, IL$41.10–$61.65 / hourProvides input to Managers on learning and development needs of team members on assigned shifts, mentoring of new staff, and mentoring and identification of future leaders 2. Identifies and delegates work experience opportunities appropriately to develop skills in various areas 3. Promotes recognition of associates and celebrates accomplishments within and across teams 4. Identifies and purses opportunities for own self-improvement and leadership development including participation in hospital committees and projects, and attending internal and external conferences 5. Works with teams to develop, implement and track results of quality improvement activities contributing to overall quality of care, KRA goals and regulatory requirements 2. Understands departmental productivity measures and uses monitoring, data reports, technology and assessment tools to assess the effectiveness of work hour and labor cost efficiency 3. Gathers, records, and responds to staffing needs according to fluctuations in staffing and census updating AdvocateWorks schedule as needed.
NewRegistered Nurse - RN TEEMA GroupRegistered Nurse - RNCrestwood, IL$85,000–$95,000This position is responsible for assessing patient needs, developing and implementing care plans, coordinating services, and evaluating outcomes to ensure holistic and high-quality healthcare delivery. Monitor and manage both acute and chronic patient conditions in various settings, promoting continuity of care and supporting transitions between home, assisted living, nursing, or hospital care as needed.
Registered Nurse Case Manager Team Select Home CareRegistered Nurse Case ManagerValparaiso, Indiana$70,000–$85,000 / yearEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: visit schedule with frequency of visits, complete medication profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient’s care needs, name and contact information of the agency’s Clinical Manager. Acts as an advocate for patient welfare and coordinates care between patients, their families/caregivers and/or their authorized representative, the agency and other healthcare providers/facilities/ outside agencies.
Registered Nurse Case Manager Support Team Select Home CareRegistered Nurse Case Manager SupportValparaiso, IndianaA Registered Nurse (RN) / Case Manager Support administers and/or oversees the skilled nursing care of patients in their place of residence in accordance with physician orders and the plan of care per state Practice Act. Acts as an advocate for patient welfare and coordinates care between patients, their families/caregivers and/or their authorized representative, the agency and other healthcare providers/facilities/ outside agencies.
NewRN Home Health TEEMA GroupRN Home HealthCrestwood, IL$85,000–$95,000This position is responsible for assessing patient needs, developing and implementing care plans, coordinating services, and evaluating outcomes to ensure holistic and high-quality healthcare delivery. Monitor and manage both acute and chronic patient conditions in various settings, promoting continuity of care and supporting transitions between home, assisted living, nursing, or hospital care as needed.
NewRN Care Manager TEEMA GroupRN Care ManagerCrestwood, IL$85,000–$95,000This position is responsible for assessing patient needs, developing and implementing care plans, coordinating services, and evaluating outcomes to ensure holistic and high-quality healthcare delivery. Monitor and manage both acute and chronic patient conditions in various settings, promoting continuity of care and supporting transitions between home, assisted living, nursing, or hospital care as needed.
CASE MANAGER-Registered Nurse PRN Methodist HospitalsCASE MANAGER-Registered Nurse PRNMerrillville, IndianaAbility to assess and interpret data about the patients status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.
Inpatient RN Care Manager Advocate Aurora Health IncInpatient RN Care ManagerPark Ridge, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
Inpatient Care Manager (RN) Advocate Aurora Health IncInpatient Care Manager (RN)Libertyville, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
RN Care Manager Advocate Aurora Health IncRN Care ManagerDowners Grove, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
CASE MANAGER RN required Methodist Hospitals IncCASE MANAGER RN requiredMerrillville, INAbility to assess and interpret data about the patient''s status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient. Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
CASE MANAGER- RN required Methodist HospitalsCASE MANAGER- RN requiredMerrillville, IndianaAbility to assess and interpret data about the patient's status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient. Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
Registered Nurse (RN)-Inpatient Care Manager Full Time 8-4:30 Weekend and Holiday Rotation Advocate Aurora Health IncRegistered Nurse (RN)-Inpatient Care Manager Full Time 8-4:30 Weekend and Holiday RotationOak Lawn, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.