- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Sharecare (Columbus, OH)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Molina Healthcare (Columbus, OH)
- …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… more
- Actalent (Columbus, OH)
- …management + Prior authorization + Utilization review + Clinical review + Patient care + Licensed registered nurse Additional Skills & Qualifications ... Job Description The Authorization Specialist will perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines… more
- Fresenius Medical Center (Dublin, OH)
- …require approval from Clinical Services and Education Note: If a student nurse has completed an approved PCT certification program, please refer to PCT Student ... for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training...policies and procedures. Based on the length of the clinical placement, the student nurses may perform all or… more
- Fresenius Medical Center (Columbus, OH)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Westerville, OH)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- ChenMed (Columbus, OH)
- …our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare ... This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere… more
- ChenMed (Columbus, OH)
- …and maximizing their healthy time at home. The Register Nurse (RN) Community Care Nurse will serve as a clinical lead for a Community Care team. They will ... has completed their episode of care management the register nurse (RN) will review patient chart for...clinical field preferred. + A valid, active Registered Nurse (RN) license in State of employment required. +… more
- CVS Health (Columbus, OH)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CVS Health (Columbus, OH)
- …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- Option Care Health (Columbus, OH)
- …relate to telephonic nursing support and management. + Provide excellent communication to nurse colleagues regarding patients on service with review of current ... and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health...of an accredited school of nursing + Current Registered Nurse (RN) licensure in the state of practice +… more
- Fresenius Medical Center (Columbus, OH)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience,… more
- Surgery Care Affiliates (Dublin, OH)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... will. Responsibilities We are actively hiring for an Registered Nurse (RN) PreOp PACU. + Promote the mission, vision,...with other disciplines as needed. + Participate in quality review and performance improvement projects. + Participate in the… more
- OhioHealth (Columbus, OH)
- …interdisciplinary team. The Lead RN Navigator participates in some aspects of clinical care. This position exists in various departments throughout the OhioHealth ... throughout the year Able to use and understand the computer to document and review information in and out of the counseling room OTHER DUTIES AS ASSIGNED: Please… more
- OhioHealth (Columbus, OH)
- …Perform very invasive procedures and requires high level of independent clinical decision-making. **Responsibilities And Duties:** Works under direction and in ... needs a Supervisory Physician Agreement submitted to the Medical Board of Ohio yearly review w Practice to submit to State Medical Boar d . Practices within… more
- Sedgwick (Columbus, OH)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual Hindi, Japanese, Mandarin or more **We are looking… more
- OhioHealth (Columbus, OH)
- …communication with the medical staff to initiate and support collaborative clinical management practices, policies and procedures. Assumes role of Asst Manager ... and functions clinically as CVRT, Cardiac Sonographer, or Registered Nurse , as qualified. Maintains radiation safety program/lead checks. Participates in… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be given to those… more