- CVS Health (IL)
- …And we do it all with heart, each and every day. Job Profile Summary The Utilization Management Physician Reviewer ensures timely and clinically sound ... care expertise, and attention to detail are essential for success. Role Description: The Utilization Management Physician Reviewer -FT role is responsible… more
- Evolent (Springfield, IL)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... with the Director of UM to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory of the United States. +… more
- Evolent (Springfield, IL)
- …supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description + Reviews charts and analyzes ... you will be a key member of the utilization management team. We can offer you...cases that an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed,… more
- Elevance Health (Chicago, IL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Virtual:** This role enables associates to...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Health Care Service Corporation (Chicago, IL)
- …to obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience + Insurance Industry ... accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB...of operations. + 3 years of clinical experience in physician office, hospital, or surgical setting. + Customer service… more
- Evolent (Springfield, IL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... Medical Director's direction, using independent nursing judgement and decision-making, physician -developed medical policies, and clinical decision-making criteria sets. The… more
- Huron Consulting Group (Chicago, IL)
- … Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, ... are now and create your future. The Manager of Utilization Management is responsible for planning, organizing,...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Carle Health (Champaign, IL)
- …and works with our Utilization Management RN team, Clinical Denials Management team and the Physician Advisor Team which is comprised of five other ... management , case management and clinical denials management . + The Behavioral Health Physician Advisor...the new providers regarding utilization and case management objectives. + Conducts medical record review … more
- R1 RCM (Chicago, IL)
- …must have strong selling skills and the ability to engage clinical leadership teams, utilization review (UR), and case management departments. You will ... and Retrospective Chart Reviews + Level-of-Care Determinations + Compliance Support for Utilization Management and Case Management Processes This position… more
- ChenMed (Oak Lawn, IL)
- …explain primary care provider role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for… more