- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Springfield, IL)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Springfield, IL)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- US Tech Solutions (Chicago, IL)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. + Considers all documented...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- CVS Health (Springfield, IL)
- …time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Utilization Management nurses use specific criteria ... paced environment NICU experience 3+ years **Preferred Qualifications** Previous Utilization Management experience Spine Experience **Education** Associates… more
- CVS Health (Springfield, IL)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Springfield, IL)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Rush University Medical Center (Chicago, IL)
- …Offers may vary depending on the circumstances of each case. **Summary:** The Clinical Nurse Leader (CNL) functions as an advanced generalist providing and ... The CNL provides insight regarding the microsystem for collaboration with the Clinical Nurse Specialist (CNS) on macrosystem processes and outcomes. The… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …CC Coordinator possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... Summary The Community Care EHRM Clinical Care Coordinator acts as subject matter expert...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more