- Trinity Health (Columbus, OH)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN , Utilization Review Case Manager** **Why Mount Carmel?** With five hospitals ... www.experiencecolumbus.com ! **About the job:** The ** RN Case Manager, Utilization Review ** ensures...Licensure / Certification: Current license to practice as a Registered Nurse ( RN ) in the… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference… more
- Bon Secours Mercy Health (Lorain, OH)
- …and operational excellence. **Primary Function/General Purpose of Position** The Admissions Coordinator Registered Nurse ( RN ) is responsible for the ... to acute rehab unit. Maintains expertise in clinical field, utilization review and case management;...of Science Nursing (required) **Work Experience** 3 years of Registered Nurse ( RN ) clinical experience… more
- Help at Home (Cleveland, OH)
- …a clinically safe and fiscally responsible level of home care personnel utilization + Perform patient visits during peak periods or during staffing shortages ... presenting any required disciplinary action + Responsible for the interdisciplinary team case conferences, staff meetings and in the decision to accept patient care… more
- Cleveland Clinic (Mayfield Heights, OH)
- …from an accredited school of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through ... and appreciation, and build a rewarding career. As an RN Case Manager, you will collaborate with...approved entity + Two years of recent experience in utilization review , quality or care management +… more
- Cleveland Clinic (Cleveland, OH)
- …from an accredited school of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic Life Support (BLS) certification through ... of the most respected healthcare organizations in the world. RN Case Managers work collaboratively with inter-professional...or AHA). + 2 years of recent experience in utilization review , quality or care management. +… more
- Premier Health (Dayton, OH)
- …5 years of job related experience** **Prior job title or occupational experience: Case management, Utilization review ** Preferred experience: Knowledge of ... Bachelor's degree** Additional requirements: Type of degree: Nursing Licensure/Certification/Registration ** Registered nurse with valid Ohio license. Certification… more
- Guardian Life (Columbus, OH)
- … case management to facilitate collaboration toward RTW goals. Utilization of independent vendors to perform independent medical assessments. Specifically define ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... **EXPERIENCE** **Required** + 7 years in any combination of clinical, case / utilization management and/or disease/condition management experience, or provider… more
- Molina Healthcare (OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- CVS Health (Columbus, OH)
- …Care Management Programs to change lives in new markets across the country. The Case Manager, Licensed Practical Nurse is responsible for care coordination of ... nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- Medical Mutual of Ohio (OH)
- …may substitute for a degree. + 3 years progressive experience in health plan case management or utilization review which includes training and curriculum ... the state of Ohio in one of the following: Registered Nurse ( RN ), Licensed Practical...(LISW) or Licensed Social Worker (LSW). + Certification in Case Management, Training, Project Management or nationally recognized health… more
- Medical Mutual of Ohio (OH)
- …Ohio State Nursing Board. Bachelor's degree preferred. + 3 years experience as a Registered Nurse in acute care, critical care, emergency medical or medical ... medical coding or medical documentation investigation preferred. **Professional Certification(s):** + Registered Nurse with current State of Ohio unrestricted… 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 ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Lincoln Financial (Columbus, OH)
- …Critical Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's ... looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Sedgwick (Columbus, OH)
- …and client satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for ... business lines; and to provide expertise in client specific case management and utilization review ...promote maximum performance. **QUALIFICATIONS** **Education & Licensing** Current unrestricted RN license in a state or territory of the… more
- Cleveland Clinic (Beachwood, OH)
- …Graduate from an accredited school of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Three years of clinical nursing experience ... This position requires 2 years of experience in Utilization Review , Quality or Care Management,...respected healthcare organizations in the world. As Disability Plan Nurse , you will primarily review short-term disability… more
- Select Medical (Avon, 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
- Battelle Memorial Institute (Columbus, OH)
- …critical care or a related area is required. + Licensure to practice as a Registered Nurse in Ohio is required. + Must be capable of using respiratory ... experiences and welcome all qualified individuals to apply. **Job Summary** The nurse provides clinical and administrative support for the operation of a… more