• Utilization Management Strategy…

    Humana (Springfield, IL)
    …Excel). **Preferred Qualifications** + Exposure or experience with clinical operations and/or utilization management . + Health care industry experience. ... help us put health first** Join Humana as a Utilization Management (UM) Strategy Principal, and play...to develop and implement actionable, data-driven strategies that streamline care delivery and reduce unnecessary costs for both members… more
    Humana (10/22/25)
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  • Utilization Management Clinician-…

    CVS Health (Springfield, IL)
    …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
    CVS Health (10/22/25)
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  • Utilization Management Clinical…

    CVS Health (Springfield, IL)
    …facilitate optimal care /treatment. + Identifies members who may benefit from care management programs and facilitates referral. + Identifies opportunities to ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
    CVS Health (10/26/25)
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  • Utilization Management…

    Humana (Springfield, IL)
    …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Job… more
    Humana (10/10/25)
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  • Clinical Registered Nurse - Utilization…

    Cognizant (Springfield, IL)
    …- Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Regardless of your working arrangement, we are here to support a healthy work-life balance though our various wellbeing... revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
    Cognizant (10/07/25)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... objectives **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. +… more
    US Tech Solutions (10/17/25)
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  • Sr. Clinical Sales Executive - Central Region

    Danaher Corporation (Chicago, IL)
    …that includes some of the following: infection detection/control, sepsis care , decision support , utilization management , case management , ED patient ... decision making-we are enabling clinicians to deliver the best possible care to their patients with improved efficiency, clinical confidence, adaptive collaboration,… more
    Danaher Corporation (10/19/25)
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  • Outpatient Care Management RN

    Carle Health (Hoopeston, IL)
    …other reporting mechanisms to support high reliability performance and outcome evaluation.Outpatient Care Management RN functions as an arm of the primary ... 1 day remote and 4 in office The OP Care Management RN provides care ...relationship to utilize healthcare resources appropriately minimizing unnecessary healthcare utilization .Conduct holistic health care assessment including health… more
    Carle Health (09/18/25)
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  • Manager, Care Management

    Humana (Springfield, IL)
    …and help us put health first** Humana Gold Plus Integrated is looking for Managers of Care Management who will lead teams of nurses, care coordinators and ... behavioral health professionals responsible for care management . The Manager, Care Management ,...of staff including service performance and adherence to established utilization and care coordination benchmarks. **Use your… more
    Humana (08/29/25)
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  • Primary Care Physician

    ChenMed (Oak Lawn, IL)
    …ability to make informed decisions re: goals of care , palliative care and hospice. + Utilization /Financial Management -managing resource utilization ... history, physical exam, diagnosis and treatment, development of the plan of care , health education, specialty referrals, case management referrals, follow-up and… more
    ChenMed (09/02/25)
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