Nurse Reviewer II - Chicago, IL

A Utilization Review Nurse will perform medical reviews of claims suspended for medical necessity using medically accepted criteria. · ...

This position performs medical review of claims suspended for medical necessity using medically accepted criteria. · Candidates must reside in TX or IL · ...

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 ...

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 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 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 approach promotes productivity and supports work-life integration. · ...

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 ...

+Job summary · Lensa does not hire directly for these jobs but promotes them on behalf of its direct clients. · +Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. · Evaluates documentation/information to de ...

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 Utilization Review Nurse 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. · ...

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. · ...

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 ...

+The Pre-Certification Review Nurse Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications+, · +Review and process all requests for specialty medications. · Maintain a working knowledge of all clin ...

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 ...

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. · ...

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

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 ...