- Cognizant (Columbus, OH)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Columbus, OH)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Columbus, OH)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient… more
- Fresenius Medical Center (Columbus, 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
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… 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 ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses... clinical experience in an acute care setting. **This role… more
- Molina Healthcare (Columbus, OH)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- OhioHealth (Columbus, OH)
- …Heart Association, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job Description:** Current ... careers and in our communities. **Job Description Summary:** The RN Clinical Leader provides leadership and coordinates the design, development, implementation and… more
- CVS Health (Columbus, OH)
- …a member's overall wellness through integration. - Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and ... functions as well as smooth transition to programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- Molina Healthcare (Columbus, OH)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Datavant (Columbus, OH)
- …clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Molina Healthcare (Columbus, OH)
- 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 ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services… more
- Trinity Health (Grove City, 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 ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses...to readmit to the hospital. + Assures all appropriate clinical information is provided to outside agencies. + Communicates… more
- Trinity Health (Westerville, OH)
- …for:** + 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 ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… 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 ... or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing… more
- Molina Healthcare (Columbus, OH)
- …behavioral health, or equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... Required Qualifications * At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the… more
- Gentiva (Columbus, OH)
- …Administrator to join our leadership team. This role is ideal for a licensed Registered Nurse (RN) with strong leadership experience in hospice care, home ... health, or clinical operations management. If you're a natural leader who...growth through census development, referral management, and efficient resource utilization + Maintain strong relationships with physicians, referral sources,… 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 ... or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN… more