- R1 RCM (Chicago, IL)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- Prime Therapeutics (Springfield, IL)
- …and enters data of these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings ... work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse (RN). + 5 years of post-degree clinical... Nurse (RN). + 5 years of post-degree clinical experience. + Experience in managed care, specialty drugs,… more
- AdventHealth (Glendale Heights, IL)
- …60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records ... algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level...order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor… more
- Sharecare (Springfield, IL)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical,… more
- Trinity Health (Berwyn, IL)
- …**Description:** The Lead Case Manager position reports to the Manager of Nurse Care Management. Their specific duties include: + Recruiting, interviewing, hiring, ... oriented, and safe practice. Position responsibilities: + Actively participates in clinical performance improvement activities. + Assists in the collection and… more
- CVS Health (Springfield, IL)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.… more
- Humana (Springfield, IL)
- …responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare members. You will also ... facilitate the delivery of high quality, appropriate, and consistent clinical decision making to ensure appropriate outcomes and drive better quality health outcomes… more