Nurse Utilization Reviewer

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...

About 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...

Job 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...

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...

We 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...

Job 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...

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...

Job 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...

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...

Salary 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...

Ascension 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...

Key ResponsibilitiesParticipate 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...

Elevance 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,...

Job 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...

About UsLa Rabida Children's Hospital is a leading pediatric hospital in Chicago, IL, dedicated to providing high-quality care to children with complex conditions, disabilities, and chronic illnesses.Job DescriptionWe are seeking a highly skilled Care Management and Utilization Leader to join our team at La Rabida Children's Hospital in Chicago, IL. This is...

Job 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...

About 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 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.

Key ResponsibilitiesThe ideal candidate will possess excellent clinical judgment and communication skills, with the ability to work effectively in a fast-paced environment.Your primary duties will include:Conducting initial medical necessity clinical screenings and determining whether the presented information meets medical necessity criteria.Notifying...

About the RoleWe are looking for a Nurse Practitioner to join our team as a Utilization Management Expert. As a key member of our healthcare team, you will be responsible for developing and implementing strategies to optimize healthcare resource utilization.Key ResponsibilitiesAnalyze data and metrics to identify areas for improvement and develop targeted...