- Humana (Columbus, OH)
- …where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager , you will spearhead audit and validation ... relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management....skills to make an impact** **Required Qualifications** + Registered nurse (RN). + 5 or more years of clinical… more
- Elevance Health (Independence, OH)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within… more
- Elevance Health (Mason, OH)
- …Monday - Friday, 9am - 5:30pm (4 days) 11:30am - 8pm (1 day) EST** The ** Nurse Case Manager Senior** is responsible for care management within the scope of ... functions as preceptor for new care management staff. Participates in department audit activities. Position Requirements: + Requires BA/BS in a health related field… more
- Fresenius Medical Center (Hinckley, OH)
- …any other treatment related data into systems. + Ensures regulatory, compliance, and audit activities are accomplished on time. + Orients and supports all new home ... therapies staff and provides ongoing education, ensuring compliance with all risk management initiatives, including in-center staff. + Responsible for hiring, coaching, and counseling employees, including performance reviews, disciplinary action, and… more
- Molina Healthcare (Dayton, OH)
- …programs. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500 & UB04 claim… more
- Sunrise Senior Living (Findlay, OH)
- …Sunrise of Findlay **Job ID** 2025-234353 **JOB OVERVIEW** The LPN Medication Care Manager is responsible for providing the highest degree of quality care and ... medication updates from Resident Care Director (RCD) or Wellness Nurse . + Administer, assist with, and observe medications and...supervisor. + Count all narcotics with another Medication Care Manager (MCM) or Lead Care Manager (LCM)… more
- Trinity Health (Columbus, OH)
- …call your own in Columbus. Learn more at www.experiencecolumbus.com The Registered Nurse Clinical Lead will supervise all clinical staff and assist physicians with ... person's physical, emotional, social and spiritual needs within the scope of the Ohio Nurse Practice Act. The Registered Nurse functioning in the spirit of… more
- Molina Healthcare (Akron, OH)
- …**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional ... to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides supporting documentation for… more
- CVS Health (Columbus, OH)
- …travel if a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . The Pharmacy Program Manager role includes: -Collaborate with an ... with heart, each and every day. The Pharmacy Program Manager is an individual contributor (non-people manager )...interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Function/General Purpose of Position** The Risk Score Accuracy (RSA) Program Manager provides leadership, oversight, coordination, and subject matter expertise for ... forums with BSMH coders and Revenue Cycle team, BSMH Compliance and Internal Audit teams, Ensemble coding and billing leaders, BSMH leaders, and Population Health… more
- Medical Mutual of Ohio (OH)
- …business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems ... planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS...more junior-level Analyst. May supervise staff in absence of Manager + Supports HEDIS submission lifecycle processes such as… more