- CVS Health (Columbus, OH)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CVS Health (Columbus, OH)
- …active current and unrestricted RN licensure in state of residence + Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** + 3+ years of clinical experience as a Registered Nurse in a hospital setting in...or specialty area + Managed Care experience preferred, especially Utilization Management + preference for those residing… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** 3+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH Schedule: W/Th/F/Sa (4-10hr shifts)… more
- Cognizant (Columbus, OH)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... 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
- CVS Health (Columbus, OH)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- CenterWell (Columbus, OH)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- CVS Health (Columbus, OH)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… 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 ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Molina Healthcare (Columbus, OH)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Fresenius Medical Center (Columbus, OH)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… 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 ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday… more
- Elevance Health (Columbus, OH)
- …management plan and modifies as necessary. + Assists with development of utilization /care management policies and procedures. + Participates in or leads ... ** Nurse Care Manager II** **Location: Ohio** **Virtual:** This...with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs… more
- Highmark Health (Columbus, OH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… 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 ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Elevance Health (Columbus, OH)
- …preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or call center experience preferred. + RN Compact License is ... CST, with a comp day during the week) The ** Nurse Reviewer I** is responsible for conducting preauthorization, out...hospital setting or minimum of 1 year of prior utilization management , medical management and/or… more
- Molina Healthcare (Columbus, OH)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… 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 ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Highmark Health (Columbus, OH)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more