• RN , Manager , Utilization

    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
    Humana (09/28/25)
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  • Clinical Learning Facilitator - Utilization

    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
    Molina Healthcare (09/17/25)
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  • Registered Nurse ( RN ) Case…

    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 (09/04/25)
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  • RN Case Manager

    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
    Trinity Health (08/20/25)
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  • RN (Bachelor's required), Care…

    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
    OhioHealth (07/17/25)
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  • LTSS Service Coordinator - RN Clinician…

    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
    Elevance Health (09/12/25)
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  • Hospice RN Executive Director

    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
    Gentiva (09/26/25)
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  • Case Manager ( RN or MSW)…

    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
    Select Medical (09/23/25)
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  • RN Administrative Supervisor - Mount Carmel…

    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
    Trinity Health (08/13/25)
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  • Medical Claim Review Nurse ( RN )

    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 (09/06/25)
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  • Manager , Healthcare Services

    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
    Molina Healthcare (09/27/25)
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  • Care Manager

    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
    AmeriHealth Caritas (10/02/25)
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  • Case Manager - PRN

    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
    Select Medical (10/03/25)
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  • Disease Management Nurse - Remote

    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
    Sharecare (09/13/25)
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  • Medical Management Clinician

    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
    Elevance Health (09/10/25)
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  • Director, Clinical Systems

    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
    Molina Healthcare (10/01/25)
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  • Multi-Skilled Tech-Diley Ridge - Part Time Nights…

    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 (08/08/25)
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  • Operations Manager Interventional…

    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
    Trinity Health (09/04/25)
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  • Clinical Nurse Leader, Open Heart Recovery

    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
    OhioHealth (09/24/25)
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  • LTSS Service Coordinator - Clinician (LSW, LCSW,…

    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
    Elevance Health (09/12/25)
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