- CenterWell (Columbus, OH)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
- CVS Health (OH)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. **Position Summary** The Team ... projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance and support...3+ years Medical Review or Utilization Management experience. + 2 + years of experience with personal computer, keyboard navigation,… more
- CVS Health (OH)
- …RN with current unrestricted "multi-state privilege" compact license. + 3+ years of clinical experience required. + 2 + years of Utilization Management experience ... is going to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes. Schedule...- Friday 8:00am - 5:00pm. Will have to maintain clinical review skills through the annual use of IRR.… more
- Molina Healthcare (Cleveland, OH)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for ... appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and ... align with established clinical guidelines, insurance policies, and regulations - ensuring members...the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least… more
- Molina Healthcare (Akron, OH)
- **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** * At least… more