RN Utilization Review Professional
2 weeks ago
- Participate in the development and implementation of QM Work Plan activities.
- Review and evaluate complex data and information sets to identify trends and areas for improvement.
- Collaborate with internal/external clinician support teams to coordinate clinical resolution.
- Prepare and complete QM documents based on interpretation and application of business requirements.
This is a challenging yet rewarding role that requires a high level of expertise and attention to detail. If you are a motivated and organized individual with a passion for quality improvement, we encourage you to apply.
-
Healthcare Professional
4 weeks ago
Chicago, Illinois, United States Incredible Health Full timeAbout Incredible HealthHospitals partnering with Incredible Health are actively hiring and accepting applications for a Registered Nurse - Utilization Review in the Chicago, IL area.CompensationThe estimated annual salary for this position ranges from $61,300 to $100,980, depending on experience and qualifications.Job SummaryWe are seeking experienced Nurses...
-
Utilization Review Nurse Liaison
3 days ago
Chicago, Illinois, United States Mindlance Full timeAbout 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...
-
Clinical Utilization Review Specialist
4 weeks ago
Chicago, Illinois, United States Integrated Resources, Inc Full timeJob SummaryThis Clinical Utilization Review Specialist role is a vital part of our team at Integrated Resources, Inc.About the RoleWe are seeking a highly skilled and experienced Registered Nurse to join our team as a Clinical Utilization Review Specialist. In this role, you will play a crucial part in ensuring compliance with utilization management (UM) and...
-
Healthcare Utilization Review Professional
4 weeks ago
Chicago, Illinois, United States Incredible Health Full timeJob OverviewIncredible Health is seeking a skilled Healthcare Utilization Review Professional to join their team in the Chicago, IL area.CompensationThe estimated annual salary for this position ranges from $61,300 to $100,980.Job ResponsibilitiesUtilize clinical knowledge and skills to review patient cases and determine medical necessity.Collaborate with...
-
Utilization Review Nurse
1 week ago
Chicago, Illinois, United States US Tech Solutions Full timeAbout 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...
-
Nurse Utilization Reviewer
1 week ago
Chicago, Illinois, United States US Tech Solutions Full timeYour Opportunity:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. As a Nurse Utilization Reviewer - Clinical Policy, you will be responsible for reviewing documentation and interpreting data obtained from clinical records or systems to apply appropriate clinical criteria and...
-
Experienced Utilization Review Nurse
4 weeks ago
Chicago, Illinois, United States Walker HealthForce Full timeWe are seeking a skilled Registered Nurse with experience in utilization review to join our team at Walker HealthForce. As a local contract nurse RN, you will be responsible for reviewing patient cases and ensuring that medical treatments are necessary and effective.About the JobThis is a 52-week contract position with 40 hours of work per week. The shift...
-
Medical Director
4 weeks ago
Chicago, Illinois, United States Ascension Health Full timeAscension Illinois offers a competitive salary for this Physician Advisor role, with an estimated annual compensation of $250,000 to $300,000, depending on experience and qualifications. This position is based in Chicago, IL, and requires a hybrid schedule with both on-site and remote work.About the RoleThis Physician Advisor position provides medical...
-
Clinical Review Specialist
2 weeks ago
Chicago, Illinois, United States Elevance Health Full timeElevance Health seeks a skilled Clinical Review Specialist to join our team. As a valued member of our organization, you will play a critical role in ensuring the quality and efficiency of healthcare services. Your primary responsibilities will include conducting medical necessity reviews for diagnostic imaging procedures and out-of-network services,...
-
Clinical Utilization Specialist
1 week ago
Chicago, Illinois, United States PSG Global Solutions Careers Full timeJob OverviewWe are seeking a skilled Clinical Utilization Specialist to join our team. In this role, you will play a vital part in reviewing and evaluating Utilization Management (UM) plans for prospective and existing Medical Groups/IPAs in the HMO networks.Key Responsibilities:Reviews UM/QR plans to ensure compliance with HMO standards and...
-
Utilization Management Specialist
4 weeks ago
Chicago, Illinois, United States w3r Consulting Full timeJob DescriptionThe Utilization Management Specialist is a critical role at w3r Consulting, responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by Medical Groups/IPAs participating in our networks. This position requires a Registered Nurse (RN) with 3 years of clinical experience, including 2 years...
-
Clinical Reviewer Nurse
5 days ago
Chicago, Illinois, United States PSG Global Solutions Careers Full timeClinical 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...
-
Nurse Reviewer Specialist
1 week ago
Chicago, Illinois, United States Elevance Health Full timeJob 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...
-
Healthcare Utilization Manager
5 days ago
Chicago, Illinois, United States Elevance Health Full timeAbout Elevance Health: We are a healthcare company dedicated to improving lives and communities through innovative solutions and compassionate care. Our mission is to make healthcare simpler and more accessible to our members and the communities we serve.">Job Summary: We are seeking a skilled Clinical Reviewer I-5 to join our team and conduct...
-
Utilization Review Nurse
1 week ago
Chicago, Illinois, United States Guidehealth Full timeSalary and BenefitsThe estimated salary for this position is $114,000 per year, paid bi-weekly. In addition to a competitive compensation package, we offer comprehensive Medical, Dental, and Vision plans to keep you covered. We also provide Life and Disability insurance for your peace of mind and an Employee Assistance Program (EAP) to support you through...
-
Nurse Utilization Specialist
1 week ago
Chicago, Illinois, United States Guidehealth Full timeJob SummaryWelcome to Guidehealth, a data-powered healthcare company dedicated to operational excellence. We are seeking an experienced Registered Nurse with a passion for utilization review and patient care. As a Nurse Utilization Specialist, you will play a vital role in ensuring that our clients receive high-quality, cost-effective care while maintaining...
-
Utilization Management Specialist
4 days ago
Chicago, Illinois, United States Integrated Resources Full timeUtilization Management SpecialistAbout the Role:This position involves working closely with medical groups and IPAs to ensure compliance with utilization management and quality review functions. The ideal candidate will have strong analytical and communication skills, as well as experience in utilization review, quality assurance, or statistical research.
-
Real Estate Attorney Opportunity
3 days ago
Chicago, Illinois, United States Denovo Review Full timeCompany OverviewDenovo Review, a well-established Illinois-based law firm, is seeking a highly motivated and experienced attorney to join its esteemed Real Estate Practice. This exciting opportunity presents a chance to be part of a dynamic team that handles complex and sophisticated transactions for clients across various industries.This role offers a...
-
Claims Administrator Professional
4 weeks ago
Chicago, Illinois, United States Old Republic Professional Full timeJob Title: Claims Administrator ProfessionalWe are seeking a highly skilled Claims Administrator Professional to join our team at Old Republic Professional. This is an exciting opportunity to work in a dynamic environment and contribute to the growth and success of our organization.About the Company:Old Republic Professional is a subsidiary of Old Republic...
-
Tax Professional
2 weeks ago
Chicago, Illinois, United States Phang Staffing Solution Full timeJob DescriptionOverview:The Tax Senior at Phang Staffing Solution plays a vital role in ensuring compliance with tax regulations and delivering valuable tax-related insights to the organization. This position is essential in minimizing tax liabilities and ensuring accurate tax reporting, thereby contributing to the financial well-being of the company.Key...