Utilization Management Nurse
Jobtailor
Review and authorize Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) Evaluate member needs using clinical expertise and evidence-based criteria Interpret criteria, policies, and procedures related to LTSS authorizations Make coverage determinations and decisions related to denials for HCBS-covered services Coordinate and communicate with providers, members, and interdisciplinary teams Create timely and accurate authorizations and determinations Ensure compliance with Illinois HFS, contractual, and regulatory requirements Facilitate optimal care, treatment, and service delivery Support Illinois Medicaid members and providers Requirements Licensed Registered Nurse (RN) in Illinois with no disciplinary action 1+ years of experience in utilization management/LTSS service authorization 2+ years of clinical experience Comprehensive knowledge of Microsoft Word, Outlook, and Excel Must reside in Illinois Minimum internet speed of 25 Mbps download and 10 Mbps upload Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information Preferred: Bachelor's degree in nursing, Health Services, Healthcare Administration, Business Administration, or a related field Preferred: Previous Medicare/Medicaid experience Preferred: Experience in discharge planning and/or home health, HCBS, rehabilitation, or LTSS programs Core Competencies Demonstrates expertise in Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) authorizations, with a strong focus on compliance with Illinois HFS regulations and effective communication with interdisciplinary teams. Proficient in clinical evaluation and decision-making to facilitate optimal care for Illinois Medicaid members. Highest-signal resume keywords Licensed Registered Nurse (RN) Utilization Management Clinical Experience Microsoft Office Suite Medicare/Medicaid Experience ATS Optimization Keywords Hard Skills LTSS Authorization HCBS Coverage Determination Clinical Evaluation Evidence-Based Criteria Interpretation Compliance with Regulatory Requirements Soft Skills Communication Coordination Interpersonal Skills Certifications & Qualifications Registered Nurse (RN) License in Illinois Industry Keywords Illinois HFS Medicaid Home Health Discharge Planning Rehabilitation Tools & Technologies Microsoft Word Microsoft Outlook Microsoft Excel #J-18808-Ljbffr
$71.1k - $97.8k
...helping individuals access the services and support they need to live safely and independently in their communities? As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by reviewing and...SuggestedFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to FridayHumana
Springfield, IL2 days ago$32.01 - $68.55 per hour
...Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical... ...Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. Must have active...SuggestedHourly payFull timeTemporary workWork at officeLocal areaAfternoon shiftCVS Health
Springfield, IL3 days ago$32.01 - $68.55 per hour
Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical... ...Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. Must have active...SuggestedHourly payFull timeTemporary workWork at officeLocal areaAfternoon shift$2,033 per week
...Registered Nurse (RN) | Medical-Surgical Location: Springfield, IL Agency: FlexCare Pay: $2,033 per week Shift Information... ...leader in travel nursing, allied health, and therapy talent management solutions for top healthcare facilities throughout the U.S....SuggestedFull timeContract workImmediate startShift workNight shiftTravelNurseSource
Springfield, IL1 day ago- ...8am to 5pm (M-F) Description: RN working in the insurance or managed care industry using medically accepted criteria to validate the... ...care. Qualifications Required: RN with IL Active License, with Utilization experience; familiar with MCG and ASAM criteria. Preferred:...SuggestedContract work
$1,956.96 per week
...FlexCare is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Springfield, IL. Shift: 3... ...nationwide leader in travel nursing, allied health, and therapy talent management solutions for top healthcare facilities throughout the U.S....Flexible hoursShift workNight shift$2,020 per week
...Registered Nurse (RN) | Intermediate Care Location: Springfield, IL Agency: Magnet... ...care. You will assess, monitor, and manage patients' conditions, collaborating with... .... Critical Thinking and Decision Making: Utilize clinical judgment and critical thinking skills...Full timeContract workShift workMagnet Medical
Springfield, IL1 day ago- ...Recruitment Manager @ Integrated Resources, Inc | Human Resources Management Location... ...multidisciplinary teams Summary Works with the Utilization Management team primarily responsible... ..., unrestricted IL State Registered Nursing (RN) license in good standing....Contract workRemote work
Integrated Resources
Springfield, IL2 days ago $2,020 per week
...Registered Nurse (RN) | Intermediate Care Location: Springfield, IL Agency: Magnet... ...care. You will assess, monitor, and manage patients' conditions, collaborating with... .... Critical Thinking and Decision Making: Utilize clinical judgment and critical thinking skills...Contract workFlexible hoursShift workTravelNurseSource
Springfield, IL1 day ago$2,340 per week
...Registered Nurse (RN) | Telemetry Location: Springfield, IL Agency: Prime Staffing Pay: $2,340 per week Shift Information... ...fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent...Permanent employmentFull timeContract workTemporary workLocal areaShift workNight shiftTravelNurseSource
Springfield, IL1 day ago$2,340 per week
...Registered Nurse (RN) | Telemetry Location: Springfield, IL Agency: Prime Staffing Pay: $2,340 per week Shift Information... ...fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent...Permanent employmentFull timeContract workTemporary workLocal areaShift workTravelNurseSource
Springfield, IL1 day ago$2,340 per week
...Registered Nurse (RN) | Telemetry Location: Springfield, IL Agency: Prime Staffing Pay: $2,340 per week Shift Information... ...fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent...Permanent employmentFull timeContract workTemporary workLocal areaShift workTravelNurseSource
Springfield, IL1 day ago$33.62 - $57.83 per hour
...and help with oversight of daily operations, VFC/ICARE management, and supply/equipment needs. In addition, the Mobile... ...The Mobile Health Services RN Program Coordinator will utilize a systematic approach to nursing by incorporating assessment, planning, implementation...Hourly payWork experience placementLocal areaShift work- ...Hines is a nationwide, independent leader in personalized managed health care, focused on what’s important to you—comprehensive... ...service. Overview Our Case Manager role allows you to utilize your clinical nursing experience to develop a plan for meeting health care needs...Full timeWork at officeWork from homeHome officeMonday to FridayNight shift
American Geriatrics Society
Springfield, IL3 days ago $28.25 per hour
...for delegation, supervision and provision of the nursing care of a designated group of patients through utilization of the nursing process. Provides age-appropriate... ...all Joint Commission, OSHA and hospital, nurse manager specified mandatory in-services. Validates competencies...Memorial Health University Medical Center
Springfield, IL1 day ago$28.25 per hour
...to $10,000.00**** The Home Health RN provides nursing care to assigned patients through the use of... ...Care Perform age appropriate assessment utilizing critical thinking skills. Function as a case manager for a group of patients in a particular geographic...Relocation packageMemorial Health University Medical Center
Springfield, IL1 day ago$66.58k - $142.58k
...policies and programs are comprised of network management, clinical coverage, and policies.... ...using clinical tools and information/data. Utilizes case management processes in compliance... ...unrestricted Illinois (IL) Registered Nurse (RN) License 3+ years clinical practical...Hourly payFull timeTemporary workWork at officeLocal area4062 Aetna Resources, LLC
Springfield, IL20 hours ago$35.35 - $53.58 per hour
...to $10,000.00 Responsibilities The Registered Nurse is responsible for the delivery of safe patient care utilizing the nursing process of assessment, planning, implementation... ...Care hospital experience preferred. Ventilator Management experience preferred. Bachelor of Science in...Full timeLocal areaRelocation packageShift workNight shiftPrime Healthcare
Springfield, IL4 days ago- ...$30.23/Hr. Max USD $48.37/Hr. Overview *** $20,000 SIGN ON BONUS AVAILABLE *** A Registered Nurse (RN) on the Clinical Support Team (CST) will have the opportunity to utilize a wide array of skills across a variety of units and partner with multiple teams. Because of...Relocation packageFlexible hoursShift workWeekend work
Memorial Health System
Springfield, IL4 days ago $10k
...team. Grounded by our belief that outstanding care is best delivered in a team-based environment, our home health registered nurse case managers lead and collaborate to provide management and delivery of patient care plans.With our 20-year track record, Residential is a...Flexible hoursResidential Home Health and Hospice
Springfield, IL5 days ago$28.25 per hour
...Position Summary Provides nursing care to assigned patients through the use of nursing process in accordance... ...Nursing Care Perform age‑appropriate assessment utilizing critical thinking skills. Function as a case manager for a group of patients in a particular...Daily paidMemorial Health University Medical Center
Springfield, IL4 days ago$32.7 per hour
...quality critical care, including assessment, triage, and treatment utilizing standards and guidelines established by Air Methods Community... ...Functions and Responsibilities include the following: Provides nursing care within his/her scope of practice from the initial contact...Temporary workFor contractorsLive inLocal areaRelocation packageFlexible hoursAir Methods
Springfield, IL21 hours ago$31.21 - $46.81 per hour
...ESSENTIAL DUTIES AND RESPONSIBILITIES Utilizes the nursing process and collaborates with interdisciplinary team members in caring for patients. Administers prescribed medications and treatments in accordance with approved nursing techniques, policies and procedures, standards...Mercy Health
Springfield, IL3 days ago$31.21 - $49.94 per hour
...permitted by law. Job Summary: Provides direct nursing care in accordance with established... ...outcomes. Develops assessment and management strategies based on a consideration of the... ...spiritual, vocational, and leisure status. Utilizes leadership skills by coordinating and...Hourly payFlexible hoursShift workDay shiftSSM Health
Springfield, IL3 days ago$30.23 per hour
...Max USD $48.37/Hr. Position Registered Nurse (RN) – Orthopedic Unit (4E) The RN on the... ...for targeted antibiotic therapy and wound management. The unit frequently cares for... ...a designated group of patients through utilization of the nursing process. Provides age-appropriate...Full timeRelocation packageShift workWeekend workDay shiftMemorial Health University Medical Center
Springfield, IL4 days ago$31.21 - $49.94 per hour
...permitted by law. Job Summary: Provides direct nursing care in accordance with established... ...outcomes. Develops assessment and management strategies based on a consideration of the... ...spiritual, vocational, and leisure status. Utilizes leadership skills by coordinating and...Hourly payFlexible hoursShift workNight shiftWeekend workSSM Health
Springfield, IL1 day ago$28.09 per hour
...Flight Nurse IMMEDIATE HIRING! Flight Nurse Opportunity in Watson, IL Starting at $28.09 + DOE, with an additional... ...monitor and treat patients in critical care situations. Utilize critical thinking skills to manage the critically ill or injured adult or pediatric patient...Immediate startRelocationShift workRural/Metro
Springfield, IL21 hours ago- ...The Registered Nurse - ASC OR/ARD is responsible for professional nursing care of the surgical... .... Job Relationships Reports to the Nurse Manager-Operative Services Principal... ...trained to work other areas in the facility utilizing those nursing skills and techniques necessary...
Springfield Clinic
Springfield, IL8 hours ago - A health care recruitment agency is seeking a Recruitment Manager to assess and analyze clinical service requests, verify member benefits, and process prior authorizations. Candidates must have an Illinois state RN license and 1-3 years of experience in hospital or medical...Remote work
Integrated Resources
Springfield, IL2 days ago $2,056 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Springfield, IL Agency: Lancesoft Inc Pay: $2,056 per week Shift Information: Days - 3 days x 12 hours Contract Duration: 13 Weeks Start Date: 9/14/2026 About the Position TravelNurseSource...Long term contractPermanent employmentFull timeContract workTemporary workWork at officeShift workTravelNurseSource
Springfield, IL1 day ago
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