Clinical Reviewer Nurse

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,...

Your 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...

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...

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...

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 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...

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...

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...

About the JobElmhurst University's ABSN program is committed to providing high-quality education to its students. As an adjunct clinical nursing instructor, you will play a crucial role in achieving this goal by teaching and supervising students in a clinical setting.ResponsibilitiesTeach and supervise students in a clinical settingGrade student clinical...

Elmhurst University - ABSN Clinical Job DescriptionJob Type: Part-TimeLocation: Chicago, ILCompany OverviewElmhurst University values intellectual excellence, social responsibility, professional preparation, stewardship, community, and faith, meaning, and purpose. We are committed to providing a high-quality education to our students and are seeking a...

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...

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...

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...

Job SummaryWe are looking for a dedicated and experienced clinical nurse educator to join our team at Elmhurst University's ABSN program. The successful candidate will teach and mentor students in a clinical setting, ensuring they gain hands-on experience and develop the skills needed to succeed in their careers.Key ResponsibilitiesTeach and supervise...

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...

Overview:At Montrose Behavioral Health Children's Pavilion in Chicago, we are seeking a skilled Clinical Admissions Nurse to join our team. As an Admissions RN, you will play a vital role in the admissions process, ensuring smooth transitions for patients and their families.Estimated Salary: $65,000 - $90,000 per yearWe provide competitive hourly rates, free...

Job OverviewAdvocate Aurora Health is seeking a highly skilled Clinical Nurse Specialist to join our team in Chicago. This part-time position offers the opportunity to work in a clinical setting, assessing and managing patient care with independence and as part of an interdisciplinary team.ResponsibilitiesAs a Clinical Nurse Specialist, you will be...

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...

Job Summary:This is a part-time position responsible for assessing, diagnosing, and managing patient care in a clinical setting. As a Clinical Nurse Specialist, you will work independently and as part of an interdisciplinary team to ensure optimal patient care.Key Responsibilities:Assess patient conditions, determine treatment and management plans, and...