- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management. Partners with Social Workers ... field will be taken into consideration. . Professional experience with case management, utilization review , or discharge planning highly desirable. .… more
- Cleveland Clinic (Cleveland, OH)
- …or AHA Certification by an approved entity + Two years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... personal protective equipment as required for procedures Keywords: : RN, Registered Nurse, Case Management, Case Manager , RN Case Manager , Registered… more
- Premier Health (Eaton, OH)
- Case Manager FACILITY: SAMARITAN BEHAVIORAL HEALTH Case Manager functions as a member of a team to assist in the planning, development, and delivery of ... clients and uses that knowledge to coordinate services and advocate for identified clients. Case Manager acts as a resource consultant to other team members and… 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 ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… 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 ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current... prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires… more
- Cleveland Clinic (Cleveland, OH)
- …care at one of the top healthcare organizations in the nation. As an RN Case Manager , you will collaborate with inter-professional teams across the continuum of ... by an approved entity + Two years of recent experience in utilization review , quality or care management + Knowledge of acute care and accreditation… more
- Cleveland Clinic (Euclid, OH)
- …of eligibility (CTM, ACM, CCM or AHA). + Two years of recent experience in utilization review , quality or care management. + Knowledge of acute care and ... an excellent medical facility, but also a home away from home. RN Case Managers work collaboratively with inter-professional teams across the continuum of care to… more
- Highmark Health (Columbus, OH)
- …Health **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
- 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
- Bon Secours Mercy Health (Youngstown, OH)
- …Function** In the capacity of a Registered Nurse, the Ambulatory Care Manager will provide clinical care management services to identified eligible patients; ... enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management. Develop and implement care plans to maximize… more
- Select Medical (Cleveland, OH)
- …or a closely related field required. **Preferred Experience** + Experience in Utilization Review preferred + Experience in Management preferred + Experience ... stay in collaboration with the clinical team. Conducts ongoing review of the CMS data submitted and the patient's...in ICD-10 coding preferred + Experience as a Case Manager in rehabilitation preferred **Additional Data**… more
- AmeriHealth Caritas (Dublin, OH)
- **Role Overview:** The Care Manager is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, ... gaps in care and barriers to care. The Care Manager develops a plan of care through shared decision...and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs,… more
- AmeriHealth Caritas (Dublin, OH)
- **Role Overview** The Care Manager II is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, ... gaps in care and barriers to care. The Care Manager II develops a plan of care through shared...and evaluation of the effectiveness of the plan + Review medication list and educate Members with pharmacy needs,… more
- Molina Healthcare (Columbus, OH)
- …that support one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... of care and quality of Molina services provided. * Functions as hands-on manager responsible for supervision and coordination of daily activities. * Ensures adequate… more
- KPH Healthcare Services, Inc. (Maumee, OH)
- …to patients, nurses and physicians as required regarding the contents, utilization , therapeutic actions, possible adverse reactions, or interactions of drugs. + ... in all clinical activities as required, including start of care prospective review of medical and drug histories, pharmacokinetic dosing, dosage monitoring for… more
- Evolent (Columbus, OH)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- Bon Secours Mercy Health (Lorain, OH)
- …has smooth transition to acute rehab unit. Maintains expertise in clinical field, utilization review and case management; communicates to insurance ... planning and coordination. Leads rehab team meetings when covering for case manager to discuss appropriateness of program and progress of patient towards… more
- Elevance Health (Cincinnati, OH)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... granted as required by law._** The **Medical Management Nurse** is responsible for review of the most complex or challenging cases that require nursing judgment,… more
- ProMedica Health System (Toledo, OH)
- …other health care providers, family members, schools, court staff, attorneys, and case managers. Participates in utilization management activities as needed (as ... methods. Maintains related records and collaborates with other caregivers, case managers and managed care representatives. ACCOUNTABILITIES *All duties listed… more
- Elevance Health (Mason, OH)
- …policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review ... Associate Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/ Utilization ** ** Review ** **Virtual:** This role enables associates… more