- CVS Health (Columbus, OH)
- …and the candidate can live in any state. No travel is required. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- CVS Health (Columbus, OH)
- …and unrestricted RN licensure in state of residence - Must have previous inpatient utilization review experience - Must be able to work Monday through Friday ... in multiple IT platforms/systemPreferred Qualifications - Knowledge of Medicare/Medicaid - Utilization Review experience preferred - Managed care experience -… more
- CVS Health (Columbus, OH)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a ... internal and external constituents in the coordination and administration of the utilization /benefit management function Function in a clinical telephone queue… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC. Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...care innovators.Fundamentals:Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...care innovators.Fundamentals:Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- Elevance Health (Columbus, OH)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Lincoln Financial Group (Columbus, OH)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Humana (Columbus, OH)
- … management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior authorization, and ... put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to… more
- MetroHealth (Cleveland, OH)
- …- Care Coordination, plans, coordinates, and evaluates all activities impacting utilization review (eg, the centralized referral/authorization area specifically ... focusing on payer verification, preadmission processing, authorization, clincial utilization management functions, etc.). Works with the...Possess a current license to practice as a Registered Nurse in the State of Ohio. 5 years of… more
- Elevance Health (Cincinnati, OH)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Ciena Healthcare (Hamilton, OH)
- …Medicare days and RUGs utilization in the absence of the Care Management Coordinator **Qualifications:** + Registered Nurse , RN + Knowledge of the Resident ... guests under the direction and supervision of a registered nurse or a licensed practical nurse . Some...+ Assesses resident through physical assessment, interview and chart review . + Discusses resident care needs with care givers,… more
- Bon Secours Mercy Health (Springfield, OH)
- …of Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , provide and facilitate coordination of services during the acute care stay ... patients. Work directly with the patient, family/support members, inpatient case management team, and interdisciplinary care team members during admission for… more
- Fresenius Medical Center (Mansfield, OH)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN, for a limited period of time, and ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… more
- BrightSpring Health Services (Canton, OH)
- …and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate hours on ... of business development & growth, achievement of key performance indicators, management of nursing performance and staff development. Responsibilities * Oversees and… more
- Fresenius Medical Center (Kings Mills, OH)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Brook Park, 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
- Marriott (Columbus, OH)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- CenterWell (Ontario, OH)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Trinity Health (Grove City, OH)
- … Management Coordinatorwould work under the direction of the RN Care Managers, Utilization Review Care Manager and the Social Workers. He/She would function ... Type:** Full time **Shift:** **Description:** **Senior Coordinator for Case Management ** **Why Mount Carmel?** With five hospitals (https://www.mountcarmelhealth.com/find-a-location/) ,… more