- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Molina Healthcare (Columbus, OH)
- … RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
- Trinity Health (Columbus, OH)
- …Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Case Manager ** **Position Purpose:** Our RN Case Manager in collaboration with… more
- Trinity Health (Westerville, OH)
- …Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** RN Case Manager , Full-time **Why Mount...discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses… more
- OhioHealth (Columbus, OH)
- …Resuscitation - American Red Cross, DL - Driver's License - Department of Motor Vehicles, RN - Registered Nurse - Ohio Board of Nursing **Additional Job ... more - in our careers and in our communities. **Job Description Summary:** The RN Care Manager works in partnership with patients, families, caregivers and… more
- Elevance Health (Worthington, OH)
- **LTSS Service Coordinator - RN Clinician (Case Manager )** **Hiring statewide across Ohio** **Location** : This field-based role enables associates to primarily ... unless an accommodation is granted as required by law._ The **LTSS Service Coordinator- RN Clinician** is responsible for overall management of member's case… more
- Gentiva (Circleville, OH)
- …Executive Director to join our leadership team. This role is ideal for a licensed Registered Nurse ( RN ) with strong leadership experience in hospice care, ... budgeting while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain strong relationships… more
- Select Medical (Dublin, OH)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... A joint venture with Select Medical & OhioHealth **Case Manager ( RN or MSW)** **Benefits of becoming...Social Work or in a clinical or related discipline ( RN preferred), per state guidelines for case management… more
- Trinity Health (Columbus, OH)
- …years recent clinical experience in hospital setting with Care Manager /Charge Nurse or other relevant hospital management experience required. + Demonstrates ... RN Administrative Supervisor** , in collaboration with the management team, serves as a support person in planning,...strongly desired. + Current license to practice as a Registered Nurse in State of Ohio. +… more
- Molina Healthcare (Columbus, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (Columbus, OH)
- …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- AmeriHealth Caritas (Dublin, OH)
- …electronic medical record and documentation programs. **Licensure:** + A current and unrestricted Registered Nurse ( RN ) or Licensed Independent Social Worker ... **Role Overview:** ;The Care Manager is responsible for managing and coordinating care,...accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. + Monitor appropriate utilization… more
- Select Medical (Dublin, OH)
- …within the allotted time frame; assuring payments of services meeting patient-related utilization management criteria, and implementation of safe and appropriate ... + Current Licensure in a clinical discipline per state guidelines required. ( Registered Nurse or Social Work (SW) preferred) **Preferred Qualifications** +… more
- Sharecare (Columbus, OH)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager ...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
- Elevance Health (Columbus, OH)
- …moderately complex case types that do not require the training or skill of a registered nurse . **How you will make an impact.** Primary duties may include, but ... health, long term services and supports, and psychosocial needs._ **Medical Management Clinician** **Location:** This role enables associates to work virtually… more
- Molina Healthcare (Columbus, OH)
- …skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and ... including design, development, implementation, and oversight of technology that drives core utilization management , care management , long-term services and… more
- Trinity Health (Canal Winchester, OH)
- …with the mission of Diley Ridge Medical Center, under the direction of a Registered Nurse , the Multi-skilled Technician, will provide direct and indirect patient ... customer service focus. Job Relationships Reports to: Assistant Clinical Manager , Clinical Nurse Manager , Charge...- Routine Patient Care: Under the direction of an RN , or other licensed staff member. Delivers patient care… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Full time **Shift:** **Description:** Operations Manager of Interventional/Diagnostic Services serves as the front line leader to plan, ... customers, employees, and stakeholders. Position Purpose: The Interventional Services Manager functions is responsible for planning, organizing, staffing, directing,… more
- OhioHealth (Columbus, OH)
- …department resources **Minimum Qualifications:** BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing ... evidence-based patient care in a cost-effective manner, providing leadership and clinical management to members of the health care team. He/She participates in… more
- Elevance Health (Worthington, OH)
- **LTSS Service Coordinator - Clinician (Case Manager )** **Hiring statewide across Ohio** **Location** : This field-based role enables associates to primarily operate ... Coordinator-Clinician** is responsible for working under the direction/supervision of an RN , with overall responsibility for the member's case. As required by… more