HEDIS Review Nurse

We are seeking a highly skilled HEDIS Review Nurse to join our team at PSG Global Solutions in Chicago, Illinois. As an RN and LPN (LVN), you will play a critical role in ensuring the quality of patient care provided by our insurance partners.Job SummaryThis is a challenging yet rewarding opportunity for a dedicated professional who is passionate about...

Description We're looking for a HEDIS Review Nurse , working in the Insurance industry in Chicago, Illinois, 60601, United States . An RN and LPN (LVN) is responsible for annual patient chart inspection/audit. Audits are conducted to ensure that providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance...

The role of a HEDIS Abstraction Specialist at Mindlance involves medical record abstraction and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. This position requires reviewing and accurately performing comprehensive reviews of medical records to abstract relevant clinical data during HEDIS, in accordance with...

Apply now and our proprietary system will quickly have you in front of a live recruiter. The Opportunity Description We're looking for a HEDIS Coder/Abstractor, working in Insurance industry in Illinois, United States. Review medical records and document to abstract clinical data for HEDIS reporting. Identify and extract relevant details and data within...

Medical Auditor Job DescriptionHEDIS Review Nurses are responsible for conducting annual patient chart inspections to ensure compliance with regulatory standards. This role requires strong clinical knowledge, attention to detail, and excellent communication skills.About the Role:This Medical Auditor position involves:Abstracting medical records to identify...

Mindlance is seeking a highly skilled Clinical Data Abstractor to join our team. As a Clinical Data Abstractor, you will be responsible for reviewing and accurately performing comprehensive reviews of medical records to abstract relevant clinical data during HEDIS, in accordance with NCQA guidelines and technical specifications.You will work closely with the...

We are hiring a Medical Record Review Nurse to join our team at Mindlance. In this role, you will be responsible for reviewing and accurately performing comprehensive reviews of medical records to abstract relevant clinical data during HEDIS, in accordance with NCQA guidelines and technical specifications.You will work closely with the HEDIS Project Manager...

Anticipated End Date: 2024-12-19 Position Title: Nurse Reviewer Job Description: Be Part of an Extraordinary Team Title: Nurse Reviewer Location: FULLY REMOTE; candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location in Illinois. Shift: Monday - Friday, 9:30-6:00pm CST Build the Possibilities. Make an...

Clinical Review Nurse Job DescriptionWe are seeking a highly skilled Clinical Review Nurse to join our team in the Insurance industry in Chicago, Illinois.Job SummaryThis role involves reviewing patient charts to ensure compliance with standards of care. The ideal candidate will have experience with medical record review and be able to apply structured...

Job Overview:Elevance Health is seeking a skilled Nurse Reviewer to join our team. As a key member of our healthcare team, you will play a vital role in conducting preauthorization reviews for diagnostic imaging services.Key Responsibilities:Collaborate with healthcare providers and members to ensure the most appropriate use of diagnostic imaging...

Anticipated End Date: 2025-01-04 Position Title: Nurse Reviewer I Job Description: A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains,...

Anticipated End Date: 2025-01-04 Position Title: Nurse Reviewer I Job Description: A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains,...

Job Description: Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives Responsibilities: Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies...

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. Nurse Reviewer I Location: Although this...

Hospitals on Incredible Health are actively hiring and accepting applications in the Chicago, IL area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and mid...

Hospitals on Incredible Health are actively hiring and accepting applications in the Chicago, IL area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and...

About the RoleWe are seeking a highly skilled and experienced Clinical Utilization Management Specialist to join our team at Mindlance. In this role, you will be responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by Medical Groups/IPAs participating in the networks of Client's HMOs.The ideal...

Job SummaryWe are looking for a skilled Nurse Practitioner to work independently as an Independent Contractor. This part-time position offers flexible scheduling and opportunities for growth. As a member of our Clinical team, you will perform comprehensive assessments face-to-face in-home settings or via telehealth visits.Your responsibilities will include...

Anticipated End Date: Position Title: Nurse Reviewer I-5 Job Description: Location: This is a Virtual role , Must be located within 50 miles of the 233 S. Wacker Dr, Chicago IL. Schedule: 9:30am-6:00pm CST, Rotating weekend shifts. Responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging...

About the Job:We are seeking a highly skilled Utilization Review Nurse to join our team at US Tech Solutions. As a key member of our organization, you will be responsible for reviewing documentation and evaluating Potential Quality of Care issues based on clinical policies and benefit determinations. You will work closely with internal/external clinicians to...