- Cleveland Clinic (Cleveland, OH)
- …of the most respected healthcare organizations in the world. As a Utilization Management (UM) RN Reviewer supporting all inpatient units, you will play ... a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a...of professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic… more
- Molina Healthcare (Cleveland, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred… more
- Molina Healthcare (Cleveland, OH)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing....Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… more
- Molina Healthcare (Cleveland, OH)
- … and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical...payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, physicians and… more
- Fresenius Medical Center (Garfield Heights, OH)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Cleveland, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Molina Healthcare (Cleveland, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Elevance Health (Independence, OH)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Elevance Health (Seven Hills, OH)
- …following standard procedures that do not require the training or skill of a registered nurse . **How you will make an impact:** + Confirms medical services ... Medical Management Clinician Associate - 40 hours, 4-5 days/week,...a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid… more
- Select Medical (Cleveland, OH)
- …of acute transfers and other CQI indicators. **Qualifications** **Minimum Qualifications** + Registered Nurse with valid state license. Legacy employees may ... documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control… more
- Cleveland Clinic (Warrensville Heights, OH)
- …the ideal future caregiver include: + Master's Degree + Current licensure as a Registered Nurse ( RN ) + Certified Professional in Healthcare Quality (CPHQ) ... compliance with all standards and favorable performance on safety, quality, utilization , and experience metrics. + Participate in engraining the safety, quality,… more
- Cleveland Clinic (Cleveland, OH)
- …qualifications for the ideal future caregiver include: + Master's Degree + Registered Nurse + Healthcare Accreditation Certification Program (HACP) or Certified ... ensure compliance with standards and improve performance across safety, quality, utilization and experience metrics. This is an exciting opportunity to advance… more
- ChenMed (Cleveland, OH)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance,… more