Utilization Review Nurse Salary in Chicago, IL

Location: REMOTESalary: $105.00 USD Hourly - $110.00 USD HourlyDescription: Judge Healthcare is seeking a Remote Medical Director for an opening with one of our top clients ASAP!Position Details:Title: Medical DirectorLocation: Remote, Must have active CO MD licenseType of engagement: Contract to HireHours: Monday - Friday 8am-5:00pm MST, rotating weekendsSpecific Duties:The Medical Director would work primarily with the Utilization Management Team (nurses and coordinators) but would also work with the Appeals coordinators and various times with Care Management team members in discussing cases.Utilization management reviews (concurrent and retrospective to include peer reviews, as necessary)Appeals (determination of appeals if not the decision maker on the original UM decision)QOC investigations (review findings from QOC nurse to determine if standard of care was met; if there it is not met, issue findings and present the member case to peer review)Requirements/Qualifications:Must have a COLORADO medical license5+ years of clinical practice; good communication skills Ability to work in and with teams (across the organization utilization management, case management, appeal teams).Please send your resume and the job number to Sophia Kranias at [email protected] for immediate consideration and please share within your network!Thank you for your time and I look forward to hearing from and working with you.Regards,Sophia KraniasHealthcare RecruiterThe Judge GroupEmail: [email protected] Contact: [email protected] job and many more are available through The Judge Group. Find us on the web at www.judge.com

Description Clinical Operations Associate Medical Director General Orthopedic Surgery Full Time Sign on Bonus: $7,500 Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations with a preference for California. The Orthopedic Surgery Clinical Operations Associate Medical Director is responsible for performing pre-authorizations and providing quality improvement solutions for musculoskeletal procedures involving the joints, and high-tech diagnostic imaging. How you will make an impact: Determines the medical necessity of requests using clinical criteria. Performs physician-level case review of musculoskeletal utilization requests. Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service. Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments. Performs first level provider appeals of coverage decisions. Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management. Participates in physician team meetings. Participates in groups that develop, revise and enhance clinical appropriateness guidelines. Minimum Requirements: Requires MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery. Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s). Experience performing standard neurosurgical spine procedures independently. Preferred Skills, Capabilities, and Experiences: 3 years of clinical practice experience past fellowship training strongly preferred. California Resident/License strongly preferred. Spine surgery experience preferred. Experience with utilization management, especially with CMS guidelines preferred. For candidates working in person or remotely in the below locations, the salary* range for this specific position is $221,124 to $398,008. Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. 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. 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 [email protected] assistance.

Location: REMOTESalary: $35.00 USD Hourly - $45.00 USD HourlyDescription: One of our largest clients has an opening for a Clinical RN Reviewer to join their team remotely! Please send your updated resume to [email protected]. Contract: 3 months This job will have the following responsibilities: As a Clinical Reviewer, you will play a crucial role in ensuring the quality and accuracy of medical records, while also maintaining compliance with regulatory standardsIdentify any discrepancies or missing information in medical records and work with healthcare providers to obtain necessary information Qualifications & Requirements: Must be a Registered Nurse with an active license in state of residence At least 3 years of prior experience with Milliman and/or InterQual guidelines At least 3 years of experience in a Case Management/Utilization Review roleMust be comfortable working in a remote setting Audrey Sorber Healthcare Recruiter [email protected] Contact: [email protected] job and many more are available through The Judge Group. Find us on the web at www.judge.com

Description Nurse Reviewer I Location: Within 50 miles of a pulse point in Illinois Shift: 9:30 am - 6 pm CST The Nurse Reviewer 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. Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with more senior colleagues to complete non-routine reviews. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. Notifies ordering physician or rendering service provider office of the preauthorization determination decision. Follows-up to obtain additional clinical information. Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. 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. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. BA/BS degree preferred. Previous utilization and/or quality management and/or call center experience preferred. Ability to work 9:30 am - 6 pm PST Ability to work weekends if necessary New grads are encouraged to apply Knowledge in Microsoft Office (Word, Excel, Visio) 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. 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. 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 [email protected] assistance.

Careers that Change Lives Bring your talents to an industry leader in medical technology and healthcare solutions - we're a market leader and growing every day. You can be proud to sell medical technologies that are rooted in our long history of mission-driven innovation. Our expanding portfolio delivers measurable clinical and economic value - and opens doors. You will be empowered to shape your own career. We support your growth with the training, mentorship, and guidance you need to own your future success. Together, we can transform healthcare.Join us for a career in sales that changes lives.The Ear, Nose, and Throat Operating Unit is a global leader and trusted partner for innovative ENT solutions that improve patient access, outcomes, and customer satisfaction. We partner with the ENT community to understand the needs of customers and patients, delivering solutions that improve lives as we embody a culture of accountability and trust. Over the past 20 years, we have become the global market leader in three key segments - image-guided surgery, intraoperative nerve monitoring, and powered surgical instruments. We continue to launch valuable ENT solutions in these areas as well as tissue health and balloon sinus dilation.Click here to learn more about products. A DAY IN THE LIFE: The Market Development Representative is responsible for case support and selling activities. This role reports to the local district manager but has a dotted line to 1-3 area sales managers where accounts have multiple team members. The majority of time is spent maintaining established customer relationships and expanding utilization of current and adjacent products in the ENT portfolio.Responsibilities may include the following and other duties may be assigned. Responsible for developing, building, and strengthening long-term relationships with stakeholders including surgeons, nurses, administrators and key opinion leaders. Responsible for pursuing leads, assessing needs and providing product support and services to maximize the benefits derived from Medtronic's ENT products and/or services. Provides technical support during cases and informs the clinician of patient treatment options. Promotes education of the company's products and/or services. Conducts and/or evaluates market research including customers and competitors' activities. Develops and/or implements market development plans/strategies and changes as needed. Assesses customer needs and feedback regarding new products and/or modifications to existing products and communicates to internal stakeholders including R&D, Operations and Marketing. Establishes effective relationships and collaborates with other departments (Marketing, Finance, HR, Sales Training, etc.) to address key business issues and opportunities. The above statements are intended to describe the general nature and level of work being performed by employees assigned to this position, but they are not an exhaustive list of all the required responsibilities and skills of this position.We seek out and hire a diverse workforce at every level: We need fresh ideas and inclusive insights to continue to be an innovative industry leader -that's why we make it a point to seek out, attract and develop employees who are patient-centric, passionate, and who represent the same wide variety of life experiences as our patients.To learn more about Inclusion & Diversity at Medtronic Click Here Must Have: Minimum Requirements To be considered for this role, please ensure these minimum requirements are evident on your resume. A Bachelor's degree Nice to Have 2 Years of sales or clinical experience Operating Room Experience Relationships within the ENT space Preference will be given to local qualified candidates and candidates with Medtronic experience. About Medtronic Together, we can change healthcare worldwide. At Medtronic, we push the limits of what technology, therapies and services can do to help alleviate pain, restore health and extend life. We challenge ourselves and each other to make tomorrow better than yesterday. It is what makes this an exciting and rewarding place to be.We want to accelerate and advance our ability to create meaningful innovations - but we will only succeed with the right people on our team. Let's work together to address universal healthcare needs and improve patients' lives. Help us shape the future. Physical Job Requirements Required to function using healthcare universal precautions to minimize exposure to infectious disease and radiation. Ability to serve as the primary resource for scheduled and unscheduled clinical events, periodically required to work weekends, evenings and nights and may be required to engage in overnight travel within own district or neighboring districts. Ability to work efficiently and autonomously with little direction when outside of clinical events. Ability to attend national meetings, district meetings and other training as requested. Ability to wear a 7-9 lbs protective lead apron for extended periods of time in the operating room. Ability to lift up to 40 pounds. Ability to sitting, standing, and/or walking for 8+ hours per day. Ability to bend/stoop, squat and balance frequently. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus in relation to travel and operating a personal computer. Must have a valid driver's license and active vehicle insurance policy. In addition, your driving record will be reviewed and will be considered as part of your application. Must be able to drive approximately 50% of the time within assigned territory and may require overnight travel.The physical demands described within the Day in the Life section of this job description 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.A commitment to our employees lives at the core of our values. We recognize their contributions. They share in the success they help to create. We offer a wide range of benefits, resources, and competitive compensation plans designed to support you at every career and life stage. Learn more about our benefits here .In addition to Base Salary, this position is eligible for a Sales Incentive Plan (SIP), which provides the opportunity to earn significant incentive compensation for achieving or exceeding your goals. Learn more about total rewards here .The base salary range is applicable across the United States, excluding Puerto Rico and specific locations in California. The offered rate complies with federal and local regulations and may vary based on factors such as experience, certification/education, market conditions, and location. Compensation and benefits information pertains solely to candidates hired within the United States (local market compensation and benefits will apply for others).