- CVS Health (Columbus, OH)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Columbus, OH)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Molina Healthcare (Columbus, OH)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Actalent (Columbus, OH)
- …as assigned. + Comply with all organizational policies and standards. Essential Skills + Utilization management + Prior authorization + Utilization review + ... NCQA, Medicare and Medicaid regulations preferred + Knowledge of utilization management processes preferred + LPN -...management processes preferred + LPN - Licensed Practical Nurse - State Licensure required OR RN - Registered… more
- Trinity Health (Columbus, OH)
- …demeanor in difficult situations . Knowledge of the functional operations of utilization management , discharge planning, business office and third party payers ... Management Coordinator provides consultation to patients, families, and nursing personnel regarding the care of a specific disease.../ Certification: Current license to practice as a registered nurse in the State of Ohio . Experience: Minimum… more
- Evolent (Columbus, OH)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...or Oregon License Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse ) -… more
- Molina Healthcare (Columbus, OH)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Humana (Columbus, OH)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- Humana (Columbus, OH)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Elevance Health (Dublin, OH)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... fully integrated care plan. Engage the individual's support network and oversee management of their physical health, behavioral health, and long-term services and… more
- Molina Healthcare (Columbus, OH)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Select Medical (Columbus, OH)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... of the discharge planning process. The primary job functions in Case Management include: Clinical Interventions/Discharge and Care Planning Management ; Fiscal … more
- Molina Healthcare (Columbus, OH)
- …preferred. **Preferred Experience** 3-5 years clinical practice with managed care, hospital nursing or utilization management experience **Preferred License, ... the work performance of the HCS-Central Programs staff. Consults with the Management of HCS-Central Programs to devise and implement corrective action as necessary… more
- Trinity Health (Westerville, OH)
- …Responsible for quality and standards of patient care, performance improvement, program management , business operations, budget and resource utilization , and ... areas, focusing on optimal patient outcomes, regulatory, compliance, risk management , and continuous quality and process improvement. **Minimum Qualifications:** +… more
- Molina Healthcare (Columbus, OH)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- ChenMed (Columbus, OH)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... local travel EDUCATION AND EXPERIENCE CRITERIA: + ARNP or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of… more