Onsite Utilization Review Nurse - Chicago, Illinois, United States

Utilization Review Nurse · A remote position for a contract period of approximately 9 months requires candidates to reside in Texas or Illinois. · Perform accurate and timely medical review of claims suspended for medical necessity using medically accepted criteria. · Interpret c ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · 3 years clinical experience with 2 years' experience in utilization rev ...

The Nurse Reviewer II is responsible for collaborating with healthcare providers and members to promote the most appropriate use of diagnostic imaging. They conduct medical necessity clinical screenings and determine if initial clinical information meets medical necessity criteri ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. Conducts initial medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures out of network services an ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · ...

This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets m ...

This role supports the end-to-end appeals process to ensure timely, accurate, · and compliant resolution of member and provider appeals.This is a full-time position · with required participation in a rotating holiday schedule (3–4 holidays per year) and one weekend every third we ...

The Nurse Reviewer II role enables associates to work virtually full-time, except for required in-person training sessions. This approach promotes productivity and supports work-life integration. · This position is responsible for collaborating with healthcare providers and membe ...

As our Utilization Review Nurse, you will coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery, utilization of resources, and cost-effe ...

Coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery. · ...

This position involves managing member and provider appeals while ensuring compliance with relevant guidelines. · The successful candidate will collaborate with various teams to support audits and quality initiatives. ...

We are seeking a Clinical Care Manager who is passionate about advancing high-quality compliant patient-centered care through precise timely Utilization Review In this role you will apply clinical expertise regulatory knowledge to evaluate healthcare services ensure medically nec ...

Guarantee Trust Life Insurance Company (GTL) is seeking a Medical Review Nurse to join their team in Glenview, IL. The ideal candidate will have a solid clinical nursing background and prior insurance experience. · Evaluate claims for Hospital Indemnity, Medicare Supplement, Long ...

The Quality Review Nurse ensures Utilization Management (UM) and Quality Review (QR) compliance for Medical Groups/IPAs within the HMO network. · ...

We're seeking candidates who are looking for meaningful work, who want to invest in their growth, and contribute to a company built on timeless virtues and best business practices. · ...

Guarantee Trust Life Insurance Company is currently seeking a Medical Review Nurse to join our team. · We're seeking candidates who are looking for meaningful work, who want to invest in their growth and contribute to a company built on timeless virtues and best business practice ...

Description · Guarantee Trust Life Insurance Company (GTL) is currently seeking a Medical Review Nurse to join our team · Since 1936, GTL has offered cutting-edge insurance solutions and personalized service for our policyholders and distributors, while supporting personal growth ...

DescriptionRegistered Nurse will be responsible for auditing delegated Medical Groups/IPAs to ensure compliance with UM, Quality Review, and regulatory standards. · ...

+Registered Nurse will be responsible for auditing delegated Medical Groups/IPAs to ensure compliance with UM, Quality Review, and regulatory standards. · +Audit UM/QR programs for delegated provider groups · Ensure compliance with NCQA HMO, and internal standards · +Active IL RN ...

Ontario Center is hiring a Registered Nurse (RN) Unit Manager in Canandaigua, NY.Duties: · Handle all supervisory duties for assigned unit · Help establish and implement employee policies and procedures · Mentor less experienced nurses, offering clinical & career advice · Maintai ...