- Dayton Children's Hospital (Dayton, OH)
- Facility:Work From Home - OhioDepartment: Utilization Review TeamSchedule: Full timeHours:40Job Details:Under the supervision of the Manager of Utilization ... Management, the Utilization Review RN conducts medical record review for medical necessity and level of care using nationally recognized acute care… more
- CVS Health (OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+...required, BSN preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for… more
- Centene Corporation (Columbus, OH)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Humana (Columbus, OH)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- Premier Health (Dayton, OH)
- …job related experience Prior job title or occupational experience: Case management, utilization review , clinical nurse Prior specific functional ... Full -Time The CSI Clinical Analyst is a registered professional nurse with knowledge and expertise in process analysis, clinical outcome data analysis, … more
- Veterans Affairs, Veterans Health Administration (Cleveland, OH)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... to track service activities including admissions process, bed management, bed utilization across bed types, patient demographics, equipment utilization and… more
- CVS Health (OH)
- …+ 3+ years clinical nursing experience, with 1-3 years managed care experience in Utilization Review , Medical Claims Review , or other specific program ... and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their...experience in Utilization Management + 3+ years utilization review experience. **Education** + Associate degree… more
- Elevance Health (Mason, OH)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing. + Correlates review findings with ... ** Nurse Audit Senior (Operating Room)** **Virtual:** This role...Room)** **Virtual:** This role enables associates to work virtually full -time, with the exception of required in-person training sessions,… more
- CVS Health (OH)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Elevance Health (Mason, OH)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... **Medical Management Nurse ** **Location:** This role enables associates to work...** **Location:** This role enables associates to work virtually full -time, with the exception of required in-person training sessions,… more
- Elevance Health (Mason, 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 scope… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …but are not limited to: Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules are ... child. Child Care Subsidy: After 60 days of employment, full time employees with a total family income below...delivery model. Coordinates with the patient care team to review clinic appointment availability utilization to ensure… more
- Veterans Affairs, Veterans Health Administration (Cleveland, OH)
- …not limited to: Schedules patient appointments. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic ... leaves the occupation, the employee loses protected status and must meet the full VA qualification standard requirements in effect at the time of reentry to… more
- Select Medical (Cleveland, OH)
- …documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control ... Refresh** : Generous PTO and Paid Sick Time for full -time team members to maintain a healthy work-life balance...and medical CQI indicators. Analyzes results of chart review activities with appropriate staff and confers with department… more
- CVS Health (Columbus, OH)
- …MUST RESIDE IN OHIO The Care Management Associate (CMA) role is a full -time remote telework position. Qualified candidates must reside in Ohio. This position manages ... and supporting the implementation of Wellness Plans to promote effective utilization of healthcare services. This position promotes/supports quality effectiveness of… more
- Cleveland Clinic (Cleveland, OH)
- …AHA Certification by an approved entity + 2 years of recent experience in Utilization Review , Quality or Care Management + Knowledge of acute care ... join us, you could be eligible for relocation assistance. For a full list of benefits, click here (https://jobs.clevelandclinic.org/benefits-2/) . + Our Center for… more
- ChenMed (Columbus, OH)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... illnesses encountered in the older adult patient. + Takes full accountability for patient care and outcomes and appropriately...the office-in hospital, SNF, LTC or homebound. + Takes full accountability for patient care and outcomes and will… more
- Elevance Health (Cincinnati, OH)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... Hills, OH. This role enables associates to work virtually full -time, with the exception of required in person training...not require the training or skill of a registered nurse . **How you will make an impact:** + Confirms… more
- Elevance Health (Independence, OH)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN ... Management Clinician** **Location:** This role enables associates to work virtually full -time, with the exception of required in-person training sessions, providing… more