- Battelle Memorial Institute (Columbus, OH)
- …Health Technician will require performing a variety of administrative and clinical tasks, including data collection, report preparation, and coordination of ... + Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health… more
- Molina Healthcare (Columbus, OH)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Fresenius Medical Center (Columbus, OH)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Humana (Columbus, OH)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- OhioHealth (Columbus, OH)
- …Duties:** 1. 25% Screens and processes donors to include phone calls, sending packets, review completed packet, obtain medical release for donor and her baby, ... careers and in our communities. **Job Description Summary:** The Clinical Coordinator supports the day to day operations of...facilitates lab work with results review and transfer of milk to a collection site… more
- Gentiva (Columbus, OH)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Humana (Columbus, OH)
- …and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis ... independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical ...coding experience to conduct a clinical validation review of the inpatient medical record to… more
- CVS Health (Columbus, OH)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- Molina Healthcare (Columbus, OH)
- …education. + Supports process improvement initiatives and contributes to the development of clinical review guidelines and training materials. + Works under the ... appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of… more
- Datavant (Columbus, OH)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Select Medical (Columbus, OH)
- …as a resource for healthcare professionals through fostering relationships within medical facilities. With clinical expertise and problem-solving skills, you'll ... of thousands of patients every day. **Responsibilities** **What a Clinical Liaison Does** At Select Medical , we...of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse … more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Trinity Health (Columbus, OH)
- …of Case Management software along with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan. **What we are looking for:** + ... Manager MCHP is responsible for the coordination of the medical care provided to Plan members with Plan providers,...participating states + Experience: Minimum of 5-7 years of clinical nursing experience with at least 2 years experience… more
- Highmark Health (Columbus, OH)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- Insight Global (Gahanna, OH)
- …a safe, high-quality care environment. Key responsibilities include: * Overseeing all clinical aspects of hospice care, including chart review , onboarding of ... Active Registered Nurse (RN) license Minimum 3 years of hospice clinical experience (2 years may be considered if combined with management experience) At… more
- Cardinal Health (Columbus, OH)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Columbus, OH)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Molina Healthcare (Columbus, OH)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Columbus, OH)
- …of high speed required. JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...state they reside This role will be doing Utilization review for our Ohio Medicaid population, looking for clinicians… more
- Molina Healthcare (Columbus, OH)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
