Utilization review nurse jobs in Chicago, IL - 282 jobs
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Utilization Review Nurse
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Triage Register Nurse
RN Triage - Physical Medicine & Rehab - Days
Endeavor Health 3.9
Utilization review nurse job in Elmhurst, IL
Hourly Pay Range: $33.96 - $52.64 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
RN Triage - Physical Medicine and Rehab
Full time 40 hours
Hours: M-F start varies, 7a-7:30,8a- 8 hour or 9 hour days one closing day as needed
Required Travel: Yes ( Addison, Lombard, Oak Park and Woodridge)
What you will do:
Reviews patient voicemails and talks directly to patients on the telephone or via Mychart and directs patients to appropriate level of care (emergency department, urgent care centers, physician office) per protocol or provides appropriate home medical advice.
Conducts patient telephone assessment utilizingnursing skills to determine problems, intervening according to the patients need and gives instructions to patient/caregiver. Evaluates patient's and caregiver's understanding of instructions using teach-back methodology and conveys related information and issues to appropriate clinical staff by telephone or by utilizing the EMR.
Sends patients with high-risk chief complaints such as chest pain, abdominal pain, or severe headaches, signs and symptoms of stroke to emergency department immediately,
Arranges appointments for patients who do not need to go to emergency department but need to see a physician.
Escorts patients to examination rooms, obtains and electronically records vital signs, reason for visit and other patient data. Makes patient comfortable while waiting for provider.
Prepares patient for exam and/or procedure. Sets up room with necessary equipment.
Performs all immunizations and assists with diagnostic and other in office procedures (i.e., colposcopy, LEEP, ESSURE, ablation, lab tests, venipuncture, specimen collection, etc.).
What you will need:
Bachelors Degree Science Preferred
1 Year of telephone triage experience preferred, preferably in medical practice setting.
Registered Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) Current State of Illinois Registered Nurse licensure Required And
American Red Cross CPR BLS- American Red Cross Current CPR Certification OR American Heart Association Required
Benefits (For full time or part time positions):
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit ********************** .
When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.
Please explore our website ( ********************** ) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".
Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.
Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
$34-52.6 hourly 2d ago
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Infusion Nurse
Silver Cross Hospital 4.4
Utilization review nurse job in New Lenox, IL
Silver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It's the way
you
want to be treated.
Summary: Provides professional nursing skills in assessing, planning, implementing, and evaluating the nursing care for assigned patients. The Registered Nurse provides care consistent with the standards of professional nursing. Provides leadership and supervision to CNA/SNA and other healthcare workers as assigned.
Requirements:
Currently licensed as a Registered Nurse in the state of Illinois
CPR certified
OCN/ONS certified
1+ year infusion experience strongly preferred
*Sign-on Bonus*
Work Shift Details:
Days, variable start times of 7:30a-8:30a
M-F, no holidays or weekends
Benefits for You
At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.
Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:
· Medical, Dental and Vision plans
· Life Insurance
· Flexible Spending Account
· Other voluntary benefit plans
· PTO and Sick time
· 401(k) plan with a match
· Wellness program
· Tuition Reimbursement
The expected pay for this position is listed below:
$28.17 - $35.21
The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.
$56k-69k yearly est. 1d ago
Staff RN I - Float Pool
Kaiser Permanente 4.7
Utilization review nurse job in Northlake, IL
Description: Job Summary: Kaiser Permanente nurses are guided by an integrated nursing model that places patients and families in the center. The Staff Registered Nurse (RN) I practices professional nursing as defined by the Georgia Registered Professional Nurse Practice Act and by organizational policies, procedures, and guidelines. Provides nursing care for patients, members, and families to promote or restore health and to prevent illness and injury. Collaborates with members of the Health Care Team (HCT) and leaders to ensure the delivery of high quality, safe, effective, and efficient care. Essential Responsibilities: Utilizes the nursing process to assess patient health status, determine nursing diagnosis, establish nursing goals, and develop, implement, and evaluate the nursing plan of care. Completes POE and addresses care gaps during the patient encounter. Accurately documents patient data, actions, interventions, and response to treatment according to established policies and guidelines. Assists with procedures and monitors patients response during and after the procedure. Actively participates, as a member of the healthcare team, to engage patients, families, and caregivers in the coordination of patient care. Leads the nursing response to medical emergencies, if indicated. Monitors electronic messaging and emails (department InBasket) related to patient or provider requests and manages the messages or triages them to physician, associate practitioner, or others as needed. Initiates and monitors IV therapy, administration of medications, and other nursing procedures as prescribed by the physician or associate practitioner, and documents accordingly. Assesses patient and family health education needs, provides health teaching and counseling, and evaluates effectiveness of the education process. Conducts outgoing telephone calls to patients requiring follow-up care and preventative outreach. Participates in quality improvement activities and/or initiatives. Participates in departmental orientation and training of new staff. May perform other duties as assigned. Basic Qualifications: Experience Minimum one (1) year of RN clinical experience or have completed the Kaiser Permanente Georgia Nurse Residency program. Education Associates degree in nursing. License, Certification, Registration Registered Professional Nurse License (Georgia) required at hire Basic Life Support required at hire Additional Requirements: N/A Preferred Qualifications: Minimum three (3) years of clinical experience as a Registered Professional Nurse. Bachelors degree in nursing. Notes: float throughout the GA region; East service area. Gwinnett, Glenlake, Sandy Springs, Alpharetta, Forsyth. Internal Medicine/Peds/OBGYN d24ad0b8-823f-4e68-a892-2986ccdf7392
$62k-73k yearly est. 1d ago
Appeals Nurse Reviewer I
Carebridge 3.8
Utilization review nurse job in Chicago, IL
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work Schedule:
Monday through Friday: 11:30 AM - 8:00 PM, CST or PST (local time). Alternating weekends: 8:00am - 12:00pm, CST/PST (local time) and some holidays included.
A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
The Appeals NurseReviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines.
How you will make an impact:
* Validating appeal requests.
* Manage Appeal requests that come via email, fax, mailed in letters, or live live.
* Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements.
* Outreach to providers with appeal process instructions.
* Clinical review for the RBM and Surgical solution on a client specific basis.
* Notifying providers and/or members of appeal decisions.
* Maintain personal log all appeal requests assigned to ensure completion, as needed.
* Other duties as assigned.
Minimum Requirements:
* Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background.
* A current unrestricted RN license in applicable state(s) required.
Preferred Experience, Skills, and Capabilities:
* Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred.
* BA/BS degree preferred.
* Previous utilization and/or quality management and/or call center experience preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $34.69 to $54.41.
Locations: California, Illinois.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$34.7-54.4 hourly Auto-Apply 60d+ ago
Utilization Management Nurse
Integrated Resources 4.5
Utilization review nurse job in Downers Grove, IL
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Job Title: Utilization Management Nurse Consultant
Duration: 6 months (Possible ext)
Location: Downers Grove, IL
Responsibilities:
· Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
· Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
· Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.
· Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license.
· Fundamental Components & Physical Requirements include but are not limited to
· (* denotes essential functions)
· Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
· Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
· Communicates with providers and other parties to facilitate care/treatment
· Identifies members for referral opportunities to integrate with other products, services and/or programs
· Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
· Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
· Background/Experience Desired
· Managed Care experience preferred
· 3-5 years of clinical experience required
· Education and Certification Requirements
· RN consideration for LCSW) with current unrestricted state license required.
· Additional Information (situational competencies, skills, work location requirements, etc.)
· Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
· Effective communication skills, both verbal and written.
· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
· Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
· Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
· Typical office working environment with productivity and quality expectations
· Additional for Behavioral Health:
· Experience in Behavioral Health required
· Managed Care experience preferred.
· Onsite location will be Downers Grove.
· Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months).
· The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider.
Additional Job Details:
· Required to have computer skills.
· Work with-toggle between up to 5-6 applications/systems at a time.
· Travel Required: No
Qualifications
n/a
Additional Information
Kind Regards
Sumit Agarwal
732-902-2125
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
Telephonic Nurse Case Manager I
Elevance Health
Utilization review nurse job in Chicago, IL
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work Schedule: Monday to Friday from 9:00 AM to 5:30 PM EST, with 2-4 late evening shifts per month from 11:30 AM to 8:00 PM EST.
* This position will service members in different states; therefore, Multi-State Licensure will be required. *
The Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically.
How you will make an impact:
* Ensures member access to services appropriate to their health needs.
* Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
* Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiate rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues.
Minimum Requirements:
* Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual provides services in multiple states.
Preferred Capabilities, Skills and Experiences:
* Certification as a Case Manager.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $68,880 to $108,240.
Locations: Colorado; New York; Illinois
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
$68.9k-108.2k yearly 2d 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 7d ago
Pediatrics Nurse Case Manager needed in Chicago, IL
Healthplus Staffing 4.6
Utilization review nurse job in Chicago, IL
HealthPlus Staffing is seeking a Nurse Case Manager in Chicago, IL. The Nurse Case Manager will provide help to high risk infants and children getting health care and developmental services. Nurse Case Manager will be responsible for maintaining a caseload of approximately 100 active clients by conducting outreach activities and utilizing the referral system from High Risk Infant follow Up Program from the State of Illinois. Job Requirements:
Bachelor Degree in Nursing from an Accredited College or University
Minimum of 2 years' experience working in Community Health or Maternal Child and Health nursing
Must have Active nurse License in the state of Illinois
Compensation: Commensurate on experience
Benefits: Full Benefits
Pediatrics Schedule: Monday to Friday
Location: Chicago, IL
Reliably commute or planning to relocate before starting work (Required)
Education: Bachelor's (Preferred)
Experience: Nursing: 1 year (Preferred)
For more info please reach out to us at Recruitment@HealthPlusStaffing.com or call at 561-291-7787
$68k-85k yearly est. 60d+ 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. 23d ago
Nursing Case Manager - HIV Care Program - full time
Hektoen Institute for Medical Research 4.0
Utilization review nurse job in Chicago, IL
Join the mission-driven HIV Care Program of the Michael Reese Research and Education Foundation. We're looking for a Registered Nurse (recent BSN graduate accepted) who is passionate about combining clinical skills with social support services. This role requires excellent assessment skills to provide medical triage for patients who walk into the office and also have social service needs. They will provide nursing support and social service case management for patients who are living with, or at risk for HIV. This position blends nursing care, patient advocacy, and case management in a team-based, trauma-informed environment focused on vulnerable and diverse populations.
Why You'll Love This Role:
* Work at the intersection of public health, clinical care, and social justice
* Gain experience in both nursing triage and medical case management
* Contribute to a high-impact program serving people living with HIV
* Collaborate with a multidisciplinary team and community providers
* Access ongoing professional development opportunities
Key Responsibilities:
* Deliver client-centered case management, helping clients navigate housing, food, insurance, mental health, substance use treatment, and medical care
* Conduct in-depth client assessments and reassessments
* Provide nursing triage, medication management, injections, and treatments in clinical, office, and community settings
* Support clients after ER/hospital discharge, post-incarceration, or after transition from other institutions
* Manage prior authorizations, medical supplies, and medication refills
* Document interactions in EMR systems and ensure timely data entry for grant and program reporting
* Participate in case conferences, quality improvement efforts, and community collaborations
* Educate patients and families on treatment adherence, health maintenance, and wellness resources
You're a Great Fit If You:
* Are a licensed RN in Illinois or will become licensed within 3 months
* Have strong communication and organizational skills
* Are adept working with underserved and marginalized communities, including people of color, LGBTQ individuals, youth, and those impacted by trauma, incarceration, poverty, and mental health or substance use challenges
* Understand the importance of trauma-informed, culturally respectful care
* Thrive in a team setting and enjoy working with interdisciplinary professionals
* Have excellent documentation skills using EMRs and client tracking systems
Preferred Qualifications:
* Bachelor's degree in nursing (required)
* Prior experience in HIV care, community health, or public health settings preferred
* Experience with enrollment in Medicaid/Marketplace insurance, Illinois social services, pharmacy assistance programs a plus
Training and Support:
* Receive training in HIV case management (AFC Medical Case Management Training required upon hire)
* Attend at least 12 annual professional development sessions (topics include cultural competency, mental health, QI/QM, and HIV education)
* Annual cultural competency and self-care education
Schedule and environment:
* Full-time
* Clinic and office, with some visits in community or hospital settings
* Must be available for community outreach and cross-coverage when needed
Commitment to Equity:
We are deeply committed to serving diverse populations and creating a supportive, inclusive work environment for all staff.
$60k-77k yearly est. 10d ago
Regional Nurse Consultant
Bria 3.6
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 7d ago
Specialty Nurse Case Manager
CNA Holding Corporation 4.7
Utilization review nurse job in Downers Grove, IL
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
Assesses disability status, makes recommendations and identifies appropriate resources.
Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability.
Consults on case management issues in area of specialty and applies effective case management interventions.
Collaborates with medical and other providers to ensure appropriate treatment and return to work.
Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused.
Addresses causality and refers to appropriate medical expertise.
Documents according to jurisdictional, departmental and accreditation requirements.
Reporting Relationship
Typically Lead Specialty Nurse Case Manager
Skills, Knowledge and Abilities
Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures.
Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service.
Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner.
Strong interpersonal skills with the ability to effectively interact with internal and external business partners.
Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks.
Knowledge of Microsoft Office Suite as well as other business related software.
Ability to work independently.
Education and Experience
RN with BSN preferred. Eligible to sit for national case management certifications.
Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut,
Illinois
,
Maryland,
Massachusetts
,
New York and Washington,
the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$54k-103k yearly Auto-Apply 23d ago
Utility Coordinator - Road - Indiana
American Structurepoint Engineering Traffic Project Manager In Indianapolis, Indiana 4.6
Utilization review nurse job in Merrillville, IN
When you join American Structurepoint, you gain more than a career. You become part of a family of talented, passionate, good-hearted people who take pride in going the extra mile for our clients. At American Structurepoint, we are known for making the impossible happen for clients across the world who want help building and bettering their communities. We live by our values-excellence, respect, integrity, innovation, and social responsibility. We encourage our experts to try new things and explore new ideas that turn our client's dreams into reality, even if those ideas are unconventional. We invest in our people by offering excellent benefits and training, development, and mentorship opportunities that lead to a rewarding career path. If you are ready for more than a career, we invite you to explore opportunities to join our team and help us improve the quality of life for the communities we serve.
Group: Road
Position: Utility Coordinator
Location: Indianapolis, IN; Merrillville, IN; Fort Wayne, IN; Evansville, IN
Our Road group is looking for a qualified professional to join a growing and diverse team that plays an integral role in identification of utility conflicts through a thorough examination and understanding of existing utility infrastructure and proposed project scope of work.
Responsibilities
Performs plans reading and acts as liaison between designers, utility agencies and owner on behalf of clients.
Identification of utility conflicts through a thorough examination and understanding of existing utility infrastructure and proposed project scope of work.
Creation and maintenance of a Utility Conflict Matrix, Relocation Matrix, and utility relocation schedules.
Conducts utility coordination meetings, documents meeting minutes and maintains files of all activities for each utility agency.
Performs follow-up of meeting action items to assure effective coordination results.
Communicates verbally and formally the status of coordination activities so as to keep project team informed regarding utilities.
Qualifications
2+ years of construction, utility, engineering or utility coordination experience.
Indiana Department of Transportation (INDOT) utility coordination experience is recommended. INDOT UC certification a bonus.
Candidates must be sufficient in Microsoft Outlook, Excel, Word, PowerPoint and Teams. The candidate must possess good presentation skills, and most importantly an outgoing personality and strong desire to succeed.
Valid driver's license and a reliable vehicle is required, as travel to meetings is often required.
Normal office environment with occasional field site visits for progress review and quality control or estimating new work.
Other duties/responsibilities as required.
$37k-47k yearly est. Auto-Apply 60d+ 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 7d 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 9d ago
Nursing Care Coordinator - Specialty Pharmacy
Orsini Healthcare 4.4
Utilization review nurse job in Elk Grove Village, IL
Careers with real impact.
Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.
About Orsini Rare Disease Pharmacy Solutions
Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.
Our Mission
Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.
CORE VALUES
At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.
COMPENSATION & LOCATION
The compensation range for this role is $21.00-$23.00/hour, compensation will be determined based on a combination of factors, including skills, experience, and qualifications.
This hybrid position based out of our Elk Grove Village, Illinois pharmacy and requires 2-3 days or work onsite. There may involve overnight travel for customer and internal meetings, although limited.
POSITION SUMMARY
Under supervision of the Nursing Coordinator Supervisor works to locate and source and prequalified or previously qualified infusion nurses for Orsini home infusion patients. Works to prioritize urgent staffing needs and timely medication administration starts for new patients to therapy, prioritizes re-staffing needed for existing patients, and communicates via phone and email to home health agencies and independent nurses.
The position will help ensure communication between internal departments when needed to provide status updates on locating and sourcing nurses for patients. The position will escalate any urgent issues requiring further management type assistance needed to resolve to the Nursing Coordinator Supervisor or Clinical Nurse Manager. The Coordinator will maintain accurate records of work completed in the appropriate systems and ensure documents are returned back when needed from agencies or independent nurses.
ESSENTIAL JOB DUTIES:
Sourcing Nursing Agencies and Independent Nurses, performing prequalification screening for all Orsini Complex Therapies with Nursing.
Verifying Agencies and Nursing have provided all required documents and agreement to perform Orsini Patient Services for infusion at home.
Managing call volume for inbound and outbound calls and timely responses to emails.
Participating in Patient New Starts and provide statuses to therapy teams.
Updating master schedule of nursing visits for the ONA.
Assist with initiation of home health agreements and monthly metric report.
Disclaimer:
The information written in this indicates the general nature and level of work to be performed. This is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description.
REQUIRED KNOWLEDGE, SKILLS, & TRAINING:
High School diploma or equivalent required.
2+ years as Nursing Care Coordinator or relevant experience.
Para-professional certification (CNA, LPN, Pharmacy Technician, or MA) - preferred.
Ability to work in a team environment and provide support to other team members.
Understands medical terminology related to nursing.
Medical office/home health agency experienced needed. Pharmacy knowledge preferred.
Knowledgeable of the Illinois State Administrative Code within 6 months of hire.
Knowledgeable of ONA Policy and Procedures within 6 months of hire.
Microsoft office knowledge.
Strong interpersonal and interdepartmental customer service skills.
EMPLOYEE BENEFITS
We offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:
Medical Coverage, Dental, and Vision Coverage
401(k) with employer match
Accident and Critical Illness coverage
Company-paid life insurance options
Generous PTO, paid holidays, and floating holidays
Tuition reimbursement program
Hybrid work-environment.
Equal Employment Opportunity
Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.
Americans with Disabilities Act
Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.
$21-23 hourly Auto-Apply 16d 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.
How much does a utilization review nurse earn in Chicago, IL?
The average utilization review nurse in Chicago, 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 Chicago, IL
$66,000
What are the biggest employers of Utilization Review Nurses in Chicago, IL?
The biggest employers of Utilization Review Nurses in Chicago, IL are: