- Dayton Children's Hospital (Dayton, OH)
- …benefits and communicates information to payers in accordance with contractual obligations. The utilization review nurse serves as a resource to the ... timeHours:40Job Details:Under the supervision of the Integrated Care Manager, the Utilization Review RN conducts concurrent medical record review… more
- Humana (Columbus, OH)
- …**Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Kentucky compact licensure with no disciplinary action ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...to assist with social determinants and closing gaps + Review UM inpatient admission and clinical information to determine… 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
- Bon Secours Mercy Health (Tiffin, OH)
- …and clinicians are recognized for clinical and operational excellence. PRN **SUMMARY:** The Registered Nurse will manage the care provided in the patient's home ... Inputs necessary data in an accurate and timely fashion to reflect utilization review authorization. 5. Assures supervisory visits are completed per Agency and… more
- Fresenius Medical Center (Kenwood, OH)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Elyria, 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
- Humana (Columbus, OH)
- …UM Timeliness Monitoring and Reporting + Working knowledge using Power BI + Registered Nurse or Behavioral Health Licensed Professional. + Managed care, Medicaid ... + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness… more
- Ciena Healthcare (West Carrollton, OH)
- …the American Association of Nursing Assessment Coordinators (AANAC) requirements. **Qualifications:** + Registered Nurse , RN or Licensed Practical Nurse + ... traveling between West Carrollton nearby Dayton areas locations. Are you an experienced nurse who wants to remain clinically involved in patient care without being a… more
- CVS Health (Columbus, OH)
- …attend the first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday.A Registered Nurse that must hold an unrestricted license in their ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a collaborative… 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 ... Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse (RN) in good standing and currently licensed by the… more
- Marriott (Columbus, OH)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels, if necessary, as required ... that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates...informed **Education or Certification** + Must be a licensed registered nurse + Certification as an occupational… more
- Cleveland Clinic (Cleveland, OH)
- …one of the most respected healthcare organizations in the world. As a Registered Nurse (RN) Case Manager, you will work collaboratively with inter-professional ... nursing. + BSN preferred. **Certifications:** + Current State Licensed Registered Nurse (RN). + Certification by an...required. Minimum of two years of recent experience in Utilization Review , Quality, or Care Management preferred.… more
- Centerwell (Solon, 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...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Cleveland Clinic (Independence, OH)
- …and interdisciplinary education. Our ideal caregiver is someone who: * Is a Registered Nurse . * Is self-motivated and positive. * Can work independently ... in Nursing or Bachelor's degree in a related field preferred. **Certifications:** + Licensed Registered Nurse (RN) in the state of Ohio, BSN preferred. +… more
- Fresenius Medical Center (Garfield Heights, OH)
- **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) ... and with guidance from the Educator, Preceptor or in collaboration with another Registered Nurse . + Performs ongoing, systematic collection and analysis of… more
- Ciena Healthcare (Middletown, OH)
- …with American Association of Nursing Assessment Coordinators (AANAC) requirements. **Qualifications** + Registered Nurse (RN) or Licensed Practical Nurse ... Are you an experienced MDS nurse interested in the next step? The MDS...+ Assesses resident through physical assessment, interview and chart review . + Discusses resident care needs with care givers,… more
- Cleveland Clinic (Cleveland, OH)
- …highest honor an organization can receive for professional nursing practice. As a Registered Nurse (RN) Case Manager, you will work collaboratively with ... ideal future caregiver is someone who: * Is a Registered Nurse (RN). * Is flexible and...required. Minimum of two years of recent experience in Utilization Review , Quality, or Care Management preferred.… more
- Cleveland Clinic (Mayfield Heights, OH)
- …one of the most respected healthcare organizations in the world. As a Registered Nurse (RN) Case Manager, you will work collaboratively with inter-professional ... ideal future caregiver is someone who: * Is a Registered Nurse (RN) with recent inpatient, hospital...required. Minimum of two years of recent experience in Utilization Review , Quality, or Care Management preferred.… more
- Cleveland Clinic (Akron, OH)
- …one of the most respected healthcare organizations in the world. As a Registered Nurse (RN) Case Manager, you will work collaboratively with inter-professional ... ideal future caregiver is someone who: * Is a Registered Nurse (RN) with recent inpatient, hospital...required. Minimum of two years of recent experience in Utilization Review , Quality, or Care Management preferred.… more
- CVS Health (Columbus, OH)
- …and escalates quality of care issues under the guidance of a Registered Nurse . Utilizes influencing/motivational interviewing skills to ensure maximum member ... Members through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...Evaluation and Documentation of Care. In collaboration with the registered nurse and the member (and, if… more