- Elevance Health (Cincinnati, OH)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Molina Healthcare (Covington, KY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical claim and internal ... appeals review activities - ensuring alignment with applicable state and...equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- ChenMed (Cincinnati, OH)
- … nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...in-depth documentation through written progress notes and summaries. The Nurse Practitioner must demonstrate the ability to function both… more
- Elevance Health (Mason, OH)
- ** Nurse Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals** is responsible for investigating and processing and medical necessity… more
- Elevance Health (Mason, OH)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the exception of ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Nurse Audit Senior** will be responsible for identifying, monitoring, and… more
- Insight Global (Cincinnati, OH)
- Job Description Insight Global Health is looking for an experienced Trauma OR Nurse for one of our large Level 1 Trauma Center clients in the Cincinnati, OH area! ... brand new facility and adding 8 new operating rooms. This Trauma OR Nurse will be responsible for providing high-level emergency care to patients suffering from… more
- Elevance Health (Cincinnati, OH)
- **Wellness Nurse Consultant** **Sign on Bonus: $5000** **Field:** This field-based role enables associates to primarily operate in the field, traveling to client ... we will drive the future of health care. The **Wellness Nurse Consultant** position is responsible for developing and recommending customized, group-specific… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …workflows. + Participates in process improvement, professional development and peer review + Maintains active RN licensure within the states transfer center ... supervisor, subject to reasonable accommodation. Licensing/Certification + Active Registered Nurse (RN) - Required + Active multistate/compact registered nurse… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …workflows. + Participates in process improvement, professional development, and peer review . + Maintains active RN licensure within the states transfer center ... supervisor, subject to reasonable accommodation. Licensing/Certification + Active Registered Nurse (RN) - Required + Active multistate/compact registered nurse… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Fresenius Medical Center (Cincinnati, 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...Assessment physical. + Ensures completion of Annual Standing Order Review with each physician as required. **OTHER:** + As… more
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Insight Global (Cincinnati, OH)
- …shifts ONLY -13 week contract with extension possibilities Job Responsibilities The Registered Nurse is an individual who holds a current state license to practice ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …improvement committees and projects as needed. Supports Medical Staff Quality and Peer Review . **Primary focus will be on Diabetes education and care with active ... and medical staff bylaws. Includes support of the Medical Staff Quality/Peer Review function. + Collects quality indicator data and provides comparative analysis… more
- Molina Healthcare (Covington, KY)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Covington, KY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Covington, KY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (Covington, KY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (Covington, KY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (Covington, KY)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred… more