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Registered Nurse Clinical Reviewer Jobs in Illinois

Registered Nurse Clinical Supervisor
By Streamwood Behavioral Healthcare System At Streamwood, IL, United States

Are you looking for a rewarding career in Skilled Nursing? We are currently searching for a Registered Nurse Clinical Supervisor to join our friendly, caring and supportive team! We Offer Great ...

Nurse Reviewer I-9 Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
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.
Nurse Reviewer I Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Job Family: Medical and Clinical
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical screening
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Illinois, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus

Are you a Registered Nurse looking for a new challenge? Join our team as a Clinical Reviewer and use your expertise to help improve patient care! As a Clinical Reviewer, you will be responsible for evaluating medical records, assessing patient care, and providing feedback to healthcare providers. Take the next step in your career and make a difference in the lives of patients!

Overview Registered Nurse Clinical Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They are responsible for providing feedback to healthcare providers and other stakeholders on the quality of care provided. They must be knowledgeable of medical terminology, coding, and regulatory requirements. Detailed Job Description Registered Nurse Clinical Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They must be knowledgeable of medical terminology, coding, and regulatory requirements. They must be able to interpret and analyze medical records and other documents to ensure accuracy and compliance with regulations. They must be able to provide feedback to healthcare providers and other stakeholders on the quality of care provided. They must be able to identify and address any discrepancies or errors in the medical records. They must be able to communicate effectively with healthcare providers and other stakeholders. Job Skills Required
• Knowledge of medical terminology, coding, and regulatory requirements
• Ability to interpret and analyze medical records and other documents
• Ability to provide feedback to healthcare providers and other stakeholders
• Ability to identify and address discrepancies or errors in medical records
• Ability to communicate effectively with healthcare providers and other stakeholders
• Ability to work independently and as part of a team
• Ability to prioritize tasks and manage time effectively
Job Qualifications
• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• At least two years of experience in a clinical setting
• Knowledge of medical terminology, coding, and regulatory requirements
• Knowledge of medical record review and analysis
• Knowledge of quality improvement processes
• Excellent communication and interpersonal skills
• Strong organizational and problem-solving skills
Job Knowledge
• Knowledge of medical terminology, coding, and regulatory requirements
• Knowledge of medical record review and analysis
• Knowledge of quality improvement processes
• Knowledge of healthcare industry trends and best practices
Job Experience
• At least two years of experience in a clinical setting
• Experience in medical record review and analysis
• Experience in quality improvement processes
• Experience in providing feedback to healthcare providers and other stakeholders
Job Responsibilities
• Review medical records and other documents to ensure accuracy and compliance with regulations
• Interpret and analyze medical records and other documents to ensure accuracy and compliance with regulations
• Provide feedback to healthcare providers and other stakeholders on the quality of care provided
• Identify and address discrepancies or errors in