Utilization review nurse jobs in Berwyn, IL - 256 jobs
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Utilization Review Nurse
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Nurse
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Utilization Review Coordinator
Regional Nurse Consultant
Bria 3.6
Utilization review nurse job in Skokie, IL
Join us at the Nexus of care and compassion.
Regional Nurse Consultant Benefits:
Employee rewards program
BCBS healthcare coverage
401k
PTO package and paid holidays
Team-oriented work environment
Regional Nurse Consultant Responsibilities:
As a Regional Nurse Consultant, you will responsible for regulatory requirements, programs, processes, and outcomes in your facilities.
You will develop and implement nursing policies, standards, and practices.
You will responsible for nursing strategic planning.
You will oversee proper nursing department budgeting across facilities.
You will review facility level master schedules.
You will oversee survey management.
Requirements:
Regional Nurse Consultant Qualifications:
Registered Nurse in the State of Illinois in good standing
Master's degree in nursing, preferred
5 years of nursing leadership experience at the corporate level
Minimum of 10 years as a Registered Nurse
Experience overseeing large nursing teams
At least 5 years in LTC and knowledge of LTC regulations
keywords: chief of nursing services, skilled nursing finance, registered nurse, rn
Compensation details: 140000-150000 Yearly Salary
PI4417cb46b80b-37***********8
$58k-72k yearly est. 3d ago
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Nurse Case Manager
Wyndemere 3.6
Utilization review nurse job in Chicago, IL
RN or LPN Required Are you a compassionate nurse looking for a role that offers work-life balance and the opportunity to make a meaningful impact? Join our vibrant Independent Living community, where your focus will be on wellness and connection, not high-intensity clinical care. This is a unique opportunity for a Nurse Case Manager (RN or LPN) who acts as a specialized coordinator and advocate, managing the health, wellness and care needs of our Independent Living seniors to help them maintain independence.
What makes this role unique?
Consistent Schedule: Enjoy a predictable Monday-Friday schedule with no weekend shifts.
Light Nursing Duties: Minimal hands-on clinical care; your role emphasizes supporting independence and enhancing quality of life.
Resident-Centered Support: Assist residents in connecting with services, accompany them to community doctor visits, and provide wellness education to promote healthy living.
Collaborative Environment: Work alongside a dedicated team in a warm, welcoming community setting.
If you're passionate about building relationships, empowering seniors, and fostering a positive lifestyle, this position is for you!
Hours: 7:00am-3:30PM, Monday-Friday
The RHS Nurse is primarily responsible for delivering care coordination and case management services for residents and families, as well as providing ongoing education for our Independent Living residents. This is a full-time, hourly position onsite in Wheaton, IL within our Independent Living facility.
Here are a few of the daily responsibilities of an RHS Nurse:
Evaluates the physical, emotional, and social needs of residents
Maintains or improves independence through directing and educating residents, advising on appropriate adaptive equipment use
Assess resident's cognitive and physical abilities and recommends adaptation to living environment to reduce barriers of safety and well being
Assists in the orientation of new residents' adjustment to community living
Maintains appropriate and complete reports, records, physicians orders, care plans, and progress notes for residents. Assures confidentiality of resident information
Maintains communication with physicians, families, and appropriate staff regarding resident status
Assists residents and families by
Offering support in dealing logistically and emotionally with the aging process and illness
Provides accurate information and timely updates to residents and families
Addresses questions and concerns promptly, or identifies appropriate parties/resources to do so
Assist and stimulates residents to participate in social and creative activities
Assists in coordinating services for resident being admitted to and discharged from Assisted Living, Health Center, and Hospital
Monitors infections and accidents of residents and notifies families and physicians when appropriate
Monitors private duty personnel in accordance with community policies and procedure, coordinates care with agency representatives
Responds with urgency to emergent health issues of our residents
Here are a few of the qualifications we need you to have:
Minimum two years clinical or case management experience with elderly population strongly preferred
Current Registered Nurse or Licensed Practical Nurse with active license by State of Illinois
Current CPR/BLS certificate
Comprehensive understanding of the English Language; must be able to read, write, and communicate in English
Physical Requirements
Able to walk long distances 50% of the work day
Must be able to lift and carry up to 30 lbs
Must be able to push a wheelchair occupied by a resident weighing up to 200 lbs. independently
Must be able to safely respond to emergent situations throughout the entire Independent Living building
What we offer:
Up to 21 days per year of PTO
Insurance: Medical, Dental, Vision
Employee Assistance Program
Compensation: $32-35 per hour based on experience
#Clinical
If you're an enthusiastic, compassionate, senior care professional who is passionate about hospitality and senior engagement- please apply, we'd love to get to know you!
EEO Employer
$32-35 hourly 1d ago
Clinical Nurse Liaison
Alden Management Services 4.2
Utilization review nurse job in Chicago, IL
Alden Management Services -
TITLE: Nurse Clinical Liaison
REPORTS TO: Director Central Intake
Build new and maintain current relationships with the facility's referral sources. Assist facility marketing team with developing and executing Census Development plan in order to achieve overall census and payer mix goals.
II. QUALIFICATIONS
A. Valid Registered Nurse (RN) license.
B. Demonstrated success in external marketing to physicians, social workers discharge planners and other healthcare referral sources preferred.
C. Must be knowledgeable of Long Term care practices and procedures, as well as some familiarity with laws, regulations and guidelines pertaining to long-term care. A minimum of 2 years of experience in long term care (preferably marketing and/or nursing)
D. Must be able to read, write, and speak the English language in an understandable manner.
E. Must possess the ability to deal tactfully with hospitals, physicians, patients, family members, visitors, personnel, government agencies/personnel and the general public.
F. Must have patience, tact, cheerful disposition and enthusiasm.
G. Must be proficient with data tracking, trending and report writing.
III. PHYSICAL REQUIREMENTS
A. Must be able to move intermittently throughout the workday.
B. Must be able to cope with the mental and emotional stress of the position.
C. Must possess sight/ hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
D. Must be in good general health and demonstrate emotional stability.
E. Must be able to relate well and work with the ill, disabled, elderly, emotionally upset and at times hostile people within the facility.
F. Prolonged standing/walking is required.
G. May be required to lift, push, pull, and move equipment, supplies, etc., throughout the day.
H. Is subject to exposure to infectious waste, diseases, conditions, etc., including exposure to the (HIV) AIDS and Hepatitis B viruses.
IV. ESSENTIAL FUNCTIONS
A. Majority of time is spent solidifying relationships primarily with physicians, hospital discharge planners, case managers and other healthcare referral sources.
B. Provision of Alden Network information to potential and actual referral sources. Information shall include facility brochures, service-related flyers, metrics flyers, continuing education events.
C. Manage the referrals:
a. Ensure that referrals have a completed on-site assessments also meet with families when available (share DVD of Alden, complete Introduction to Alden- what they can expect (what differentiates Alden).
b. Gather and review referrals information (from case managers/discharge planners)
c. Make decisions regarding admissions
D. Communicate admissions decisions to the facility:
a. Planned/scheduled admission date
b. Financial verification needs
c. Equipment needs
d. Unusual and/or costly medication negotiations
E. Verify admission process is in place: (Coordinate with Administrator and Assistant Administrator)
a. Room readiness
b. Greeting patient/family upon arrival to explain what they can expect
c. Verifying that customer delights are in place and ensuring the IDT is aware
d. Ensuring family courtesy calls are made and discussed daily for the first 72 hours then weekly thereafter.
e. Ensuring the completion and analysis of Customer Service Surveys
f. Analysis of admissions process data
F. Responsible for preparation and participation in census development in order to discuss marketing opportunities and strategies to meet the metrics in place for each facility. Frequency of calls will be determined based on each facility need.
G. Ensure the completion of daily rounds on patients that are in the hospital
a. Meet with nurse/case manager/discharge planner regarding discharge from the hospital.
b. Identify other potential referrals.
c. Relay information to facility admissions director or MOD (if on the weekend)
H. Complete follow up (Thank You) visits with case managers/discharge planners and provide them with key metrics related to the specific patients that have been admitted from the individual hospital (customer care survey results, success with therapy, etc.)
I. Coordinate with facilities on Community marketing events and ensure follow up from these events.
J. Coordinate with Vice President of Network Services and Vice President of Public Relations in order to develop and improve the reputation of the network which includes but not limited to community outreach.
K. Provide updates to Director Central Intake and VP of Network Services
L. Develop and maintain new referral sources for the facility and Alden in general.
M. Perform other duties as assigned.
V. JOB DUTIES
A. Review the assigned facilities/ hospital market place to ensure facilities are able to maximize all business development opportunities to meet census objectives.
B. Coordinate and develop relationships with key referral sources in community to promote the success and growth of key facility metrics to demonstrate on how facility is the one of choice.
C. Coordinate and develop relationships will physicians in market to successfully gain support and educate them in order to build census both directly and indirectly through the success of the buildings.
$63k-76k yearly est. 7d ago
Field Nurse Case Manager - Chicago (South)
Arthur J Gallagher & Co 3.9
Utilization review nurse job in Chicago, IL
Introduction
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it's our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people's lives. It takes empathy, precision, and a strong sense of partnership-and that's exactly what you'll find here. We're a team of fast-paced fixers, empathetic experts, and outcomes drivers - people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you'll play a vital role in helping businesses and individuals move forward with confidence. Here, you'll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you're here, you're part of something bigger. You're part of a team that shows up, stands together, and leads with purpose.
Overview
Provides medical management to workers compensation injured employees, performing case management through telephonic and in-person contact with injured workers and medical providers. Coordinates with employers and claims professionals to manage medical care in order to return injured employee to work. This position will cover the Chicago area with a travel radius of up to 2 hours.
How you'll make an impact
Key Responsibilities:
Coordinating medical evaluation and treatment
Meeting with physician and injured worker to collaborate on treatment plan and to discuss goals for return to work
Keeping employer and referral source updated regarding medical treatment and work status
Coordinating ancillary services, e.g. home health, durable medical equipment, and physical therapy. Communicates with employers to determine job requirements and to explore modified or alternate employment.
Discusses and evaluates results of treatment plan with physician and injured worker using Evidence Based Guidelines to ensure effective outcome.
Documents case management observations, assessment, and plan.
Generates reports for referral source to communicate case status and recommendations.
Generates ongoing correspondence to referral source, employer, medical providers, injured worker, and other participants involved in the injured worker's treatment plan.
May participate in telephonic case conferences.
Maintains a minimum caseload of 35 files, and 150 monthly billable hours, with minimum 95% quality compliance.
About You
Required
Nursing or medical degree from an accredited institution with an active Registered Nursing license or medical license within the state of practice or states in which case management is performed.
2-4 years of work experience.
Responsible for completing required and applicable training, in order to maintain proficiency and licensing requirements.
Able to travel to appointments within approximately a 2 hour radius.
Intermediate to advanced computer skills; Microsoft Office, Outlook, etc.
Desired:
Bachelor's degree preferred.
Worker's Compensation experience is preferred.
Certification in related field preferred.
1-3 years of clinical experience preferred.
Work Traits:
Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice.
Advanced written and oral communication skills, along with organizational and leadership skills.
Self-directed and proactively manage assigned case files.
Demonstrates strong time management skills.
#LI-CW1
Compensation and benefits
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you'll get, depending on your job level these benefits may improve:
Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Other benefits include:
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program
And more...
The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.
We value inclusion and diversity
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as "protected characteristics") by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
$59k-77k yearly est. 7d ago
MDS/Careplan Nurse
All American Village Nursing and Rehabilitation Center
Utilization review nurse job in Chicago, IL
All American Village Nursing and Rehabilitation Center - An MDS nurse, also known as a Minimum Data Set nurse or Nurse Assessment Coordinator, is a healthcare professional primarily responsible for conducting comprehensive assessments of residents in long-term care facilities, collecting data on their health needs using a standardized "Minimum Data Set" form, and utilizing that information to develop personalized care plans, ensuring compliance with federal regulations and optimizing Medicare/Medicaid reimbursement for the facility; they often collaborate with other healthcare team members to coordinate resident care and advocate for their well-being.
Key responsibilities of an MDS nurse:
Conducting resident assessments:
Performing thorough evaluations of residents' physical, cognitive, and functional abilities upon admission and at scheduled intervals using the MDS assessment tool.
Data collection and documentation:
Accurately recording resident information on the MDS form, including medical history, functional status, cognitive abilities, and care needs.
Care plan development:
Utilizing MDS data to create individualized care plans for each resident, outlining specific goals and interventions to address their needs.
Interdisciplinary team collaboration:
Working with other healthcare professionals like physical therapists, occupational therapists, and dietitians to coordinate care and ensure care plans are implemented effectively.
Compliance monitoring:
Ensuring all MDS assessments are completed accurately and submitted on time to meet federal and state regulations.
Communication and resident advocacy:
Communicating resident needs to family members, healthcare team members, and facility management, advocating for resident well-being.
Quality improvement initiatives:
Participating in quality improvement projects to enhance resident care and maintain compliance standards.
Required skills for an MDS nurse:
Current and unrestrictive active R.N/ L.P.N Illinois State License
Strong clinical assessment skills
Excellent communication and interpersonal skills
Detail-oriented and organized approach to data collection and documentation
Ability to collaborate effectively with a multidisciplinary team
Knowledge of federal regulations related to long-term care and Medicare/Medicaid reimbursement
Understanding of the MDS assessment process and its application
$46k-72k yearly est. 7d ago
Travel RN - ER Travel Nurse Job in Aurora, IL, Nights (3x12), $1,877 Wk
Advantis Medical Staffing
Utilization review nurse job in Aurora, IL
ER travel nurse job in Aurora, IL - earn $1,877/week on a 13 week, Nights shift at a travel-friendly hospital with Advantis Medical. Looking for ER travel nursing jobs near you? This contract follows a (3×12) schedule and offers high pay, clinical experience, and the full support of the #1 rated travel nurse agency.
Whether you're planning your next assignment in Illinois or searching for "ER travel RN jobs near me", this opportunity could be the perfect fit. This travel assignment is perfect for nurses looking to be near Aurora, IL.
Don't miss out-click "I'm Interested" to start your application and connect with an Advantis recruiter to explore more travel ER nurse jobs near you.
Job Details
Facility: Mercy Medical Center
Location: Aurora, IL 60506
Explore the area! See our local guide and an interactive map further down this page.
Contract Length: 13 Weeks
Shift: Nights (3×12)
Travel Nursing Requirements:
2+ years of recent ER nursing experience.
Active Illinois RN License or Compact License (if applicable)
Benefits
Day One Benefits - Medical, Dental, Vision & 401(k)
Relocation and Travel Reimbursement
Dedicated team to help with travel & housing accommodations
Weekly Direct Deposit
$500 Referral Bonuses
Near Aurora, IL
Aurora, IL 60505. Discover your next travel nurse job near me in Aurora, the second-largest city in Illinois . Located along the Fox River, Aurora is known for its impressive architecture and diverse cultural attractions, including the Paramount Theatre. Travel nursing jobs near me in Aurora offer a blend of urban amenities and suburban comfort. This city provides a great opportunity for travel nurse jobs. Explore Aurora, a part of the vibrant Chicago metropolitan area, with flexible travel nursing jobs. Nearby cities include Naperville (60540), Joliet (60432), and Elgin (60120).
FAQs - ER Travel Nurse Jobs Near Aurora, IL
Expand All
Are there ER travel nursing jobs near Aurora, Illinois?
Yes! Advantis Medical frequently staffs ER travel RN jobs in Aurora and nearby areas like Naperville (60540), Joliet (60432) and Elgin (60120). This assignment offers $1,877 per week and is one of our top current opportunities.
Is Aurora a good location for ER travel nursing jobs?
Yes. With competitive pay, career-boosting clinical environments, and great local lifestyle perks, Aurora is a top destination for ER travel nurse jobs in Illinois.
What certifications are required for this ER travel nurse position?
Most travel ER jobs require Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), with Pediatric Advanced Life Support (PALS) often needed if pediatric patients are involved. Many facilities also prefer the Trauma Nursing Core Course (TNCC), though it's not always required. Specific requirements vary by unit-click "I'm Interested" to connect with a professional recruiter who can walk you through the exact certifications needed for this role.
Can I work as a travel nurse in Illinois with a compact nursing license?
Illinois Board of Nursing
Contact information
Website: https://idfpr.illinois.gov/profs/nursing.html
Phone: 888.687.7307
Fees
License by Exam: $91 (+$200 exam fee)
License by Endorsement: $50
Renewal: $80
Temporary License: $25
Timing
Processing Time: 6 - 8 weeks
Valid for: 2 years
Renewal Schedule: 2 years
General Information
Nurse Licensure Compact: No
Nursys: Yes
CEU Requirements: CEU Requirements: 20 hours
Helpful Links
Apply Now
Check Status
Verify License
Fingerprinting
Travel Nursing Jobs With Advantis Medical - The Gold Standard
At Advantis Medical Staffing, we take great pride in our commitment to caring for travel nurses. We are dedicated to connecting nurses with the best travel nursing jobs nationwide, while providing exceptional service that fosters a trusted partnership for life. Our mission is to deliver the "Gold Standard" in service -not only by securing your first assignment but by advocating for your long-term career goals and well-being. Experience our gold standard level of service as we create a stress-free and rewarding journey for you.
View Similar ER Jobs ⟶
Travel Nursing Job in Aurora, IL
Weekly Pay: $1,877
This pay combines taxable wages and tax-free stipends. For a full, transparent breakdown, submit the "I'm Interested" form, & a recruiter will send you the details. ×
Location: Aurora, IL 60506
Explore the area! See our local guide and an interactive map further down this page. ×
Facility: Mercy Medical Center
Specialty: ER
Duration: 13 weeks
Shift: Nights (3x12)
I'm Interested
Have a question? Call us at 214-305-6445
$1.9k weekly 7d ago
Week End Staff Nurse (LPN or RN)
Alden Lincoln Park Rehabilitation and Health Care Center 4.3
Utilization review nurse job in Chicago, IL
Alden Lincoln Park Rehabilitation and Health Care Center -
Responsible to provide direct nursing care to the customer, and to supervise the day-to- day nursing activities performed by the nursing assistants. Such supervision must be in accordance with current Federal, State, and local standards, guidelines and regulations, facility policies. The objective is to ensure the highest degree of quality care is maintained at all times.
QUALIFICATIONS
Must possess a current, unencumbered license to practice as a RN or LPN in the State of Illinois and/or Wisconsin.
Must possess current CPR certificate or become certified within two weeks of employment.
Must be knowledgeable of nursing and medical practices and procedures.
Demonstrates interest and/or knowledge in care of the aged.
Must be able to read, write, and speak the English language in an understandable manner.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must possess the ability to deal tactfully with customers, family members, visitors, personnel, government agencies/personnel, and the general public.
Must possess leadership and supervisory ability and willingness to work harmoniously with other personnel.
Must be personable, enthusiastic, and resourceful.
PHYSICAL REQUIREMENTS
Must be able to move intermittently throughout the workday.
Must be able to cope with the mental and emotional stress of the position.
Must possess sight/hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
Must function independently, have flexibility, personal integrity, and the ability to work effectively with customers, family members, personnel, and support agencies.
Must be in good general health and demonstrate emotional stability.
Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and at times hostile people.
May be required to lift, push, pull and move equipment, supplies, and customers in excess of fifty (50) pounds throughout the day.
Is subject to exposure to infectious waste, diseases, conditions, etc., including exposure to the (HIV) AIDS and Hepatitis B viruses.
Morning: 7am-3pm
Evening- 3pm-11pm
Night- 11pm-7am
Formulary Strategy & UtilizationReview Pharmacist
Shape the drug benefit landscape-analyze and optimize medication use.
Key Responsibilities:
Review prescribing trends and propose cost-saving alternatives.
Maintain evidence-based formularies across multiple payers.
Conduct retrospective DUR and prepare stakeholder reports.
Qualifications:
PharmD with managed care, DUR, or pharmacy benefit experience.
Strong Excel/data analytics background preferred.
Understanding of clinical guidelines and P&T processes.
Why Join Us?
Join a top-tier managed care team
Hybrid flexibility
Strategic and data-driven focus
$61k-71k yearly est. 60d+ ago
Utilization Review Nurse
Us Tech Solutions 4.4
Utilization review nurse job in Chicago, IL
+ Participates in the development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives **Responsibilities:**
+ Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.
+ Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
+ Data gathering requires navigation through multiple system applications.
+ Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
+ Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
+ Responsible for the review and evaluation of clinical information and documentation.
+ Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
+ Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).
+ Independently coordinates the clinical resolution with internal/external clinician support as required.
+ Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data
+ Prepares and completes QM documents based on interpretation and application of business requirements
+ Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
+ Assists in the development and implementation of QM projects and activities
+ Accountable for completing and implementation of QM Work Plan Activities
**Experience:**
+ 3+ years of experience as an RN
+ Registered Nurse in state of residence
+ Must have prior authorization utilization experience
+ Experience with Medcompass
**Skills:**
+ MUST HAVE MEDCOMPASS or ASSURECARE exp.
+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.
+ MUST HAVE UM experience, inpatient utilization management review.
+ MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.
+ MUST HAVE 6 months of Prior Authorization.
**Education:**
+ Active and unrestricted RN licensure in state of residence
**Questionnaire:**
+ Do you have experience with Medcompass?
+ Do you have experience with Prior Authorization?
+ Do you have experience with UtilizationReview?
+ Do you have an Active Registered Nurse License?
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$62k-76k yearly est. 60d+ ago
Utilization Review Registered Nurse
Hines 4.3
Utilization review nurse job in Elgin, IL
Requirements
QUALIFICATIONS:
Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC.
Successful completion of UR nurse orientation program.
Minimum of 3 years recent acute clinical practice required, 5 years preferred.
Managed care, disability or workers compensation experience helpful but not mandatory.
Customer service oriented.
*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.*
Salary Description $57,244 - $62,180 per year
$57.2k-62.2k yearly 26d ago
Utilization Review Coordinator (UR)
Lake Behavioral Hospital
Utilization review nurse job in Waukegan, IL
JOIN OUR TEAM AS A UTILIZATIONREVIEW COORDINATOR (UR)
$2,000 Sign-On Bonus
Your Work Matters
How will you make a difference?
The UtilizationReview (UR) Coordinator is responsible for contacting external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient's stay as well as assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning. The UR Coordinator is responsible for having a thorough understanding of the patient's treatment through communication with the treatment team. The UR Coordinator advocates for the patient's access to services during treatment team meetings and through individual physician contact. The UR Coordinator chairs the treatment team meetings and completes medical necessity reviews as indicated.
Monday Friday 8:00am 4:00pm
Your Experience Matters
What we're looking for:
Education & Education:
Degree in nursing, social work, mental health/behavioral sciences, or related field required; Master's degree preferred.
Experience:
A minimum of two (2) years' experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, discharge planning, utilization management, and/or case management.
Your Care Matters
What we provide for our team:
401(k) + matching
Health insurance
100% company-paid life insurance coverage up to 2x your annual salary
Vision insurance
Dental insurance
100% company-paid long term disability insurance
Paid time off
Paid holidays
Cafeteria on site + discounted meals
Employee engagement events
Employee assistance program
Employee recognition program
Free parking
What sets us apart:
Career & training development opportunities
Dynamic and inclusive work environment
Engaged management team dedicated to your success
A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations
Disclaimer: Benefits are subject to change at the discretion of Lake Behavioral Hospital.
Compensation:
This is a full-time role and the expected compensation range is starting at $53,000. We're eager to engage with all qualified candidates, and consideration will be provided to experience and skill level. Join us as our UtilizationReview Coordinator.
Get to know us
Outstanding Care, Compassionate People, Unparalleled Service
Discover a fulfilling career at Lake Behavioral Hospital (LBH)!
We are a 161-bed acute care facility located in Waukegan, IL and has been providing mental health treatment to the community and the state of Illinois since 2018. We are dedicated to offering services to meet the ever-changing emotion and behavioral healthcare needs of adolescents, adults, and their families. We offer specialized inpatient programs and outpatient services proven to decrease symptoms of mental illness and we are committed to help people live healthier lives. Our compassionate and experienced team of psychiatrists, licensed therapists, nurses and support staff are here to create an atmosphere of health, hope, and healing.
Join us in providing exceptional care and contributing to the well-being of individuals and families in need, and be a part of the transformative healthcare experience at Lake Behavioral Hospital.
To learn more about LBH, visit us at: ***************************************
TOGETHER WE CAN MAKE POSITIVE I.M.P.A.C.T.S.
I
ndividuals Maintaining Positive Attitude and Commitment To Service
____________________________________________________________
At Lake Behavioral Hospital, we value a diverse, inclusive workforce and provide equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.
$53k yearly 13d ago
Regional Nurse Consultant
Nexus Health Management 4.4
Utilization review nurse job in Skokie, IL
Full-time Description
Join us at the Nexus of care and compassion.
Regional Nurse Consultant Benefits:
Employee rewards program
BCBS healthcare coverage
401k
PTO package and paid holidays
Team-oriented work environment
Regional Nurse Consultant Responsibilities:
As a Regional Nurse Consultant, you will responsible for regulatory requirements, programs, processes, and outcomes in your facilities.
You will develop and implement nursing policies, standards, and practices.
You will responsible for nursing strategic planning.
You will oversee proper nursing department budgeting across facilities.
You will review facility level master schedules.
You will oversee survey management.
Requirements
Regional Nurse Consultant Qualifications:
Registered Nurse in the State of Illinois in good standing
Master's degree in nursing, preferred
5 years of nursing leadership experience at the corporate level
Minimum of 10 years as a Registered Nurse
Experience overseeing large nursing teams
At least 5 years in LTC and knowledge of LTC regulations
keywords: chief of nursing services, skilled nursing finance, registered nurse, rn
Salary Description $140000 - $150000 / per year
$140k-150k yearly 26d ago
Nurse Case Manager - Chicago
Triune Health Group
Utilization review nurse job in Chicago, IL
About TRIUNE Health Group TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive-both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager?
Be part of a well-established, family-owned company that prioritizes people over profits.
Experience our culture of
People Helping People
, where every team member is treated with dignity and respect.
Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance.
Perks & Benefits:
Generous Time Off: 20 days of vacation plus 8.5 paid holidays
Retirement Savings: 401(k) match to help you plan for the future
Comprehensive Insurance: Medical, dental, and vision coverage
Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance
Employee Support: Employee Assistance and Referral Program
Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor
Travel Perks: Mileage and travel reimbursement
TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience. I. Summary of Position: The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. II. Essential Duties and Responsibilities:
Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source.
Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual's progress.
Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness.
Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication.
Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients' homes when required.
Communicate medical information clearly and compassionately to patients and families.
Stay current with medical terminology and the federal and state laws related to health care, Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA.
Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA.
Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals.
Possess a valid driver's license with the ability to travel 90% of the time.
Perform other duties as assigned.
III. Job Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities:
Proven leadership skills.
Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations.
Methodical in accomplishing job-related goals.
Strong analytical and organizational skills, including the ability to multitask with attention to detail.
In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet.
Maintain a friendly, professional attitude at all times.
Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities.
Dependability and adaptability.
Education and Experience:
Graduate of an accredited school of nursing.
Current RN licensure in the state of operation.
Fluency in English (speaking, reading, and writing).
Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology.
CCM preferred.
Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS. IV. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The base salary range/hourly rate listed is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position is also eligible for incentive compensation awards. You may be eligible for the following competitive benefits: medical, dental, vision, life, accident & disability, short and long-term disability, paid holidays, paid time off and 401 (k). The salary range for this position is $80,000 - $90,000 annually, based on experience and qualifications.
$80k-90k yearly 60d+ ago
Business Development Liaison Nephrology & Nursing Homes
Shifa Global Solutions LLC
Utilization review nurse job in Chicago, IL
Job DescriptionBenefits:
401(k) matching
Bonus based on performance
Health insurance
Paid time off
About us: Shifa Nephrology Associates LLC is a growing, patient-focused nephrology practice dedicated to delivering high-quality, proactive, and preventive kidney care to patients across our community. As part of our mission to serve vulnerable and underserved populations, we are expanding our services to nursing homes and post-acute care facilities.
We are seeking an experienced, motivated professional to join our team as a Business Development Liaison
Position Overview
The Business Development Liaison will represent Shifa Nephrology Associates LLC in developing and maintaining strong relationships with skilled nursing facilities (SNFs), long-term care centers, and assisted living communities. This role focuses on supporting facility staff, enhancing communication, and ensuring patients have timely access to high-quality nephrology care.
The Liaison will also identify opportunities for practice growth by engaging new facilities and expanding partnerships, while upholding the mission of providing compassionate, accessible kidney care to underserved populations.
Key Responsibilities:
Develop and maintain relationships with leadership and staff at nursing homes and related facilities. Promote the practices nephrology services and educate partners on the value of timely kidney care.
Manage existing referral sources to ensure continued satisfaction and communication.
Monitor market trends and recommend strategies to expand the practices footprint.
Identify and establish relationships with new nursing home and post-acute care partners to grow the network.
Conduct regular on-site visits, meetings, and presentations with facility staff.
Monitor referral patterns and report progress to practice leadership.
Collaborate with the clinical team to ensure smooth onboarding and ongoing coordination of care.
Qualifications:
Previous experience in healthcare marketing, business development, or account management (preferably in nursing home or post-acute care settings).
Strong interpersonal and communication skills; able to build trust and rapport quickly.
Self-motivated, goal-oriented, and comfortable working independently.
Knowledge of the healthcare industry and referral processes; experience in nephrology or specialty medicine is a plus.
Valid drivers license and reliable transportation for local travel.
What We Offer:
Competitive salary and performance incentives.
Comprehensive benefits package (health, dental, retirement, etc.).
Supportive and collaborative team environment.
Opportunity to directly contribute to the growth of a specialty medical practice and make a meaningful impact on patient care.
$62k-78k yearly est. 12d ago
Nurse Consultant
Polaris Pharmacy Services
Utilization review nurse job in Des Plaines, IL
WHO WE ARE At Polaris Pharmacy Services, we're more than a pharmacy - we're a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we're raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.
Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job - we provide competitive pay, robust benefits, and genuine opportunities for career advancement.
If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.
Job Summary:
The Nurse Consultant position is an external position for Polaris Pharmacy Services with the function of providing services to skilled nursing facilities and assisted living facilities.
Duties/Responsibilities:
Serve as Liaison between the pharmacy and long-term care facility
Identify areas deficient in drug availability, drug storage, and distribution
Conduct quality assurance audits prior to survey window to ensure the facility is compliant with the applicable federal and state requirements as it relates to pharmacy services
Provide applicable educational programs required in assisting the facility in attaining and maintaining compliance
Train the trainer in-service for Medication Administration Program
Assist with new facility start-up implementation
Provide reports to the Director of Nursing, Quality Assurance Program.
Assist with interim facility/community reviews and focused audits including controlled substance reconciliation upon request from the Consultant on matters related to pharmacy issues or pharmacy requests.
Follow all applicable government regulations including HIPAA
Other duties as assigned; Job duties may vary depending on business needs
Qualifications
QUALIFICATIONS/COMPETENCIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Skills/Abilities:
Ability to read, write, speak and understand the English language
Must have good communication, speaking and writing skills
Must be willing to travel, including overnight
Must demonstrate good time management skills including good planning and adherence to a schedule
Experience using Microsoft Word, Excel, PowerPoint, and Outlook
EDUCATION and/or EXPERIENCE:
Must be a graduate of an Accredited School for Registered Nursing.
Current Registered Nurse license active and in good standing in the State of practice required
Long-term care facility clinical experience
Hospice experience preferred
PHYSICAL DEMANDS
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
May be necessary to work extended hours as needed
May lift and/or move up to 30 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
HOLIDAY & PTO POLICY
Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.
Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.
BENEFITS for full time Employees
Medical, Dental, and Vision insurance
401 (k) (available for Part Time & Full Time EEs)
Company Paid Life insurance
Short-term and Long-term disability insurance
Tuition reimbursement
Personal Time Off (PTO)
Competitive pay with annual performance reviews and merit-based raises
Career growth potential
Annual on-site voluntary Flu Vaccines
Employee referral bonus program
$55k-76k yearly est. 9d ago
Hospice Transitional Nurse Liaison - Part Time
Celtic Health Care
Utilization review nurse job in Lisle, IL
Job Title Hospice Transitional Nurse Liaison - Part Time Additional Location(s) Employee Type Employee Working Hours Per Week 8 Job Description Maintain a number of responsibilities for the ongoing daily operation of the Agency. Serve as the primary interface to the Agency's referral sources such as physicians, Hospital SWs and discharge planners, hospital RNs, and all staff in the acute care setting. Obtain complete and accurate information from the patient medical records upon request for our hospice services. Ensure a safe transition from one level of care to another. Gather and share complete information on these complex patients.
ESSENTIAL DUTIES AND RESPONSIBILITIES
include the following. Other duties may be assigned as necessary.
* Complete an initial, comprehensive, and ongoing assessment of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illness(es)
* Obtain complete/accurate demographic information and medical history, including diagnosis for care and primary care physician information
* Introduce the Agency to the patient/caregiver, explain scope of our services and skilled services requested, and coordinate start-of-care visit
* Order requested DME, supplies, and medications related to hospice care
* Deliver community education as requested for assisted living facilities, skilled nursing facilities, and hospitals
* Provide patient education at bedside regarding hospice, disease progression, and end-of-life care
* Attend discharge planning meeting as requested, working with the facility team to provide a safe and successful discharge home
* Determine hospice eligibility and appropriate level of care
* Communicate with the clinical team on all complex, chronically ill patients, assisting staff and referral sources to prevent re-hospitalizations
* Use Liaison Coordination note to communicate information
* Assist in obtaining regulatory documentation as required
* Provide professional nursing care by utilizing all elements of nursing process
* Regularly re-evaluate patient and family/caregiver needs
* Initiate the plan of care and make necessary revisions as patient status and needs change
* Uses health assessment data to determine nursing diagnosis
* Develop a care plan that establishes goals based on nursing diagnosis and incorporates palliative nursing actions; include the patient and family in the planning process
* Counsel the patient and family in meeting nursing and related needs
* Provide health care instructions to the patient as appropriate per assessment and plan
* Complete, maintain, and submit accurate and relevant clinical notes regarding patient condition and care given
* Record pain/symptom management changes/outcomes as appropriate
* Communicate with the physician regarding the patient's needs and report changes in the patient's condition; obtains/receives physicians' orders as required
* Communicate with community health-related persons to coordinate the care plan
* Teach the patient and family/caregiver self-care techniques as appropriate
* Provide medication, diet, and other instructions as ordered by the physician and recognize and utilize opportunities for health counseling with patients and families/caregivers
* Work in concert with the interdisciplinary group
* Provide and maintains a safe environment for the patient
* Assist the patient and family/caregiver and other team members in providing continuity of care
* Follow up as needed and appropriately with doctor's office and clinical and management staff pertaining to any concerns regarding patient care
* Participate in on-call duties as defined by the on-call policy
* Supervise ancillary personnel and delegate responsibilities when required
* Assume responsibility for personal growth and development and maintain and upgrade professional knowledge and practice skills through attendance and participation in continuing education and in-service classes
* Actively participate in quality assessment performance improvement teams and activities
* Prepare and maintain clinical documentation according to Agency policies and acceptable nursing standards
* Act as a Customer Service Liaison between the company and GIP facilities
* Comply with Company's Core Values and Core Competencies
* Perform other duties as assigned by supervisor
QUALIFICATION REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Associate degree from an accredited School of Nursing
* A minimum of two (2) years of experience working as a Registered Nurse including acute care or oncology experience, hospice experience preferred
* Experience with technologies such as Microsoft Office Suite, EPIC, and HCHB preferred
* Able to meet the physical demands of providing nursing care, ambulating patients, transferring patients, assisting with exercises, etc.
* Able to transfer patients as needed according to proper techniques of body mechanics to promote patient and staff safety
* Able to use good and sound clinical judgment
* Able to document accurately and appropriately
* Hold, in good standing, a license as a Registered Nurse
* CPR certified
* Empathetic, non-judgmental, tactful, responsible, and organized
* Understand the team approach and be a supportive team member
CERTIFICATES, LICENSES, REGISTRATIONS
Must have and maintain in good standing professional license, certificate, or registration, as applicable.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Employee will be required to drive daily for meetings and/or visits to residential homes. Employee will work in varied residential environments based on assigned case load. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.
COMMENTS
This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.
NOTICE:
* Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
* By supplying your phone number, you agree to receive communication via phone or text.
* By submitting your application, you are confirming that you are legally authorized to work in the United States.
Residential Home Health and Residential Hospice is an Equal Opportunity Employer
$62k-78k yearly est. Auto-Apply 28d ago
Hospice Transitional Nurse Liaison - Part Time
Graham Healthcare Group
Utilization review nurse job in Lisle, IL
Maintain a number of responsibilities for the ongoing daily operation of the Agency. Serve as the primary interface to the Agency's referral sources such as physicians, Hospital SWs and discharge planners, hospital RNs, and all staff in the acute care setting. Obtain complete and accurate information from the patient medical records upon request for our hospice services. Ensure a safe transition from one level of care to another. Gather and share complete information on these complex patients.
ESSENTIAL DUTIES AND RESPONSIBILITIES
include the following. Other duties may be assigned as necessary.
• Complete an initial, comprehensive, and ongoing assessment of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illness(es)
• Obtain complete/accurate demographic information and medical history, including diagnosis for care and primary care physician information
• Introduce the Agency to the patient/caregiver, explain scope of our services and skilled services requested, and coordinate start-of-care visit
• Order requested DME, supplies, and medications related to hospice care
• Deliver community education as requested for assisted living facilities, skilled nursing facilities, and hospitals
• Provide patient education at bedside regarding hospice, disease progression, and end-of-life care
• Attend discharge planning meeting as requested, working with the facility team to provide a safe and successful discharge home
• Determine hospice eligibility and appropriate level of care
• Communicate with the clinical team on all complex, chronically ill patients, assisting staff and referral sources to prevent re-hospitalizations
• Use Liaison Coordination note to communicate information
• Assist in obtaining regulatory documentation as required
• Provide professional nursing care by utilizing all elements of nursing process
• Regularly re-evaluate patient and family/caregiver needs
• Initiate the plan of care and make necessary revisions as patient status and needs change
• Uses health assessment data to determine nursing diagnosis
• Develop a care plan that establishes goals based on nursing diagnosis and incorporates palliative nursing actions; include the patient and family in the planning process
• Counsel the patient and family in meeting nursing and related needs
• Provide health care instructions to the patient as appropriate per assessment and plan
• Complete, maintain, and submit accurate and relevant clinical notes regarding patient condition and care given
• Record pain/symptom management changes/outcomes as appropriate
• Communicate with the physician regarding the patient's needs and report changes in the patient's condition; obtains/receives physicians' orders as required
• Communicate with community health-related persons to coordinate the care plan
• Teach the patient and family/caregiver self-care techniques as appropriate
• Provide medication, diet, and other instructions as ordered by the physician and recognize and utilize opportunities for health counseling with patients and families/caregivers
• Work in concert with the interdisciplinary group
• Provide and maintains a safe environment for the patient
• Assist the patient and family/caregiver and other team members in providing continuity of care
• Follow up as needed and appropriately with doctor's office and clinical and management staff pertaining to any concerns regarding patient care
• Participate in on-call duties as defined by the on-call policy
• Supervise ancillary personnel and delegate responsibilities when required
• Assume responsibility for personal growth and development and maintain and upgrade professional knowledge and practice skills through attendance and participation in continuing education and in-service classes
• Actively participate in quality assessment performance improvement teams and activities
• Prepare and maintain clinical documentation according to Agency policies and acceptable nursing standards
• Act as a Customer Service Liaison between the company and GIP facilities
• Comply with Company's Core Values and Core Competencies
• Perform other duties as assigned by supervisor
QUALIFICATION REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Associate degree from an accredited School of Nursing
• A minimum of two (2) years of experience working as a Registered Nurse including acute care or oncology experience, hospice experience preferred
• Experience with technologies such as Microsoft Office Suite, EPIC, and HCHB preferred
• Able to meet the physical demands of providing nursing care, ambulating patients, transferring patients, assisting with exercises, etc.
• Able to transfer patients as needed according to proper techniques of body mechanics to promote patient and staff safety
• Able to use good and sound clinical judgment
• Able to document accurately and appropriately
• Hold, in good standing, a license as a Registered Nurse
• CPR certified
• Empathetic, non-judgmental, tactful, responsible, and organized
• Understand the team approach and be a supportive team member
CERTIFICATES, LICENSES, REGISTRATIONS
Must have and maintain in good standing professional license, certificate, or registration, as applicable.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Employee will be required to drive daily for meetings and/or visits to residential homes. Employee will work in varied residential environments based on assigned case load. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.
COMMENTS
This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.
NOTICE:
Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
By supplying your phone number, you agree to receive communication via phone or text.
By submitting your application, you are confirming that you are legally authorized to work in the United States.
Residential Home Health and Residential Hospice is an Equal Opportunity Employer
$62k-78k yearly est. Auto-Apply 27d ago
Part Time Nurse Consultant with potential for long term Position (NW Indiana)
Broad Street Home Care
Utilization review nurse job in Munster, IN
🌟Part Time Nurse Consultant with potential for long-term Position (NW Indiana)
Broad Street is an established Advocacy and Private Nursing Agency serving the greater Chicagoland area and is looking to expand into NW Indiana. We are looking for a Nurse Consultant who can initially support our licensure process with IDOH. This is a unique and exciting opportunity for a nurse who is looking to join an entrepreneurial organization with other experienced Nurse Advocates and Private Nurses.
Fully Remote and flexible during licensure process (additional income compatible with other jobs and family commitments)
Periodic Collaboration with other Nurse Advocates working in Illinois to better understand our collaborative, patient-centered model
Once we gain licensure, the opportunity exists to become a Nurse Case Manager focused in Indiana:
Building strong relationships with patients, families, and medical teams
Collaborating with our HR, Scheduling, and Care Manager teams
Providing ongoing supervisory visits and client support
Acting as a patient advocate to ensure safe, high-quality care
Promoting education, independence, and self-management for clients
With a higher level of engagement and proactive support, you will play a key role in improving the quality of life for clients and shaping Broad Street's presence in Indiana.
$46k-64k yearly est. 47d ago
Nurse Case Manager
Wyndemere 3.6
Utilization review nurse job in Saint Charles, IL
RN or LPN Required Are you a compassionate nurse looking for a role that offers work-life balance and the opportunity to make a meaningful impact? Join our vibrant Independent Living community, where your focus will be on wellness and connection, not high-intensity clinical care. This is a unique opportunity for a Nurse Case Manager (RN or LPN) who acts as a specialized coordinator and advocate, managing the health, wellness and care needs of our Independent Living seniors to help them maintain independence.
What makes this role unique?
Consistent Schedule: Enjoy a predictable Monday-Friday schedule with no weekend shifts.
Light Nursing Duties: Minimal hands-on clinical care; your role emphasizes supporting independence and enhancing quality of life.
Resident-Centered Support: Assist residents in connecting with services, accompany them to community doctor visits, and provide wellness education to promote healthy living.
Collaborative Environment: Work alongside a dedicated team in a warm, welcoming community setting.
If you're passionate about building relationships, empowering seniors, and fostering a positive lifestyle, this position is for you!
Hours: 7:00am-3:30PM, Monday-Friday
The RHS Nurse is primarily responsible for delivering care coordination and case management services for residents and families, as well as providing ongoing education for our Independent Living residents. This is a full-time, hourly position onsite in Wheaton, IL within our Independent Living facility.
Here are a few of the daily responsibilities of an RHS Nurse:
Evaluates the physical, emotional, and social needs of residents
Maintains or improves independence through directing and educating residents, advising on appropriate adaptive equipment use
Assess resident's cognitive and physical abilities and recommends adaptation to living environment to reduce barriers of safety and well being
Assists in the orientation of new residents' adjustment to community living
Maintains appropriate and complete reports, records, physicians orders, care plans, and progress notes for residents. Assures confidentiality of resident information
Maintains communication with physicians, families, and appropriate staff regarding resident status
Assists residents and families by
Offering support in dealing logistically and emotionally with the aging process and illness
Provides accurate information and timely updates to residents and families
Addresses questions and concerns promptly, or identifies appropriate parties/resources to do so
Assist and stimulates residents to participate in social and creative activities
Assists in coordinating services for resident being admitted to and discharged from Assisted Living, Health Center, and Hospital
Monitors infections and accidents of residents and notifies families and physicians when appropriate
Monitors private duty personnel in accordance with community policies and procedure, coordinates care with agency representatives
Responds with urgency to emergent health issues of our residents
Here are a few of the qualifications we need you to have:
Minimum two years clinical or case management experience with elderly population strongly preferred
Current Registered Nurse or Licensed Practical Nurse with active license by State of Illinois
Current CPR/BLS certificate
Comprehensive understanding of the English Language; must be able to read, write, and communicate in English
Physical Requirements
Able to walk long distances 50% of the work day
Must be able to lift and carry up to 30 lbs
Must be able to push a wheelchair occupied by a resident weighing up to 200 lbs. independently
Must be able to safely respond to emergent situations throughout the entire Independent Living building
What we offer:
Up to 21 days per year of PTO
Insurance: Medical, Dental, Vision
Employee Assistance Program
Compensation: $32-35 per hour based on experience
#Clinical
If you're an enthusiastic, compassionate, senior care professional who is passionate about hospitality and senior engagement- please apply, we'd love to get to know you!
EEO Employer
$32-35 hourly 1d ago
Restorative Nurse
Bria 3.6
Utilization review nurse job in Elmwood Park, IL
Join us at the Nexus of care and compassion.
Restorative Nurse Benefits:
Medical/Dental/Life/Vision coverage
401k
PTO package and paid holidays
Tuition Reimbursement
Growth from within
Team-oriented work environment
Restorative Nurse Responsibilities:
As a restorative nurse, you will coordinate the restorative nursing program.
You will supervise and educate the restorative nursing staff and restorative aides.
You will assess resident health problems and needs.
You will develop and implement care plans for our residents.
Requirements:
Restorative Nurse Qualifications:
Licensed RN in the state of Illinois in good standing.
1 year or more experience in long-term care.
Restorative nursing experience preferred.
Excellent written and verbal communication skills.
keywords: restorative nurse, registered nurse, rn, restorative care
Compensation details: 40-45 Hourly Wage
PI7a45bb29033a-37***********7
How much does a utilization review nurse earn in Berwyn, IL?
The average utilization review nurse in Berwyn, IL earns between $51,000 and $85,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.
Average utilization review nurse salary in Berwyn, IL
$66,000
What are the biggest employers of Utilization Review Nurses in Berwyn, IL?
The biggest employers of Utilization Review Nurses in Berwyn, IL are: