- 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
- 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)
- ** Nurse Appeals -Licensed Nurse ** **Location** : Ohio, candidates must be residents of Ohio to be considered. **Hybrid 1** : This role requires associates to be ... necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and...leadership by managing State Fair Hearing and External Medical Review requests. .Acts as a resource for both clinical… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Function/General Purpose of Position** In the capacity of a Care Transition Nurse /Registered Nurse (RN), provide and facilitate coordination of services during ... safe placement in clinically appropriate care settings post discharge. + Perform medication review and work with members of the care team (including the patient)… 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
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are ... experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports (LTSS), or other… 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 (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 ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… 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
- Molina Healthcare (Cincinnati, 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 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 (Cincinnati, OH)
- 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 (Cincinnati, OH)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (Cincinnati, OH)
- …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
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- …the section (if appropriate), as needed. Provides guidance and support to the nurse practitioners assigned to Medical Service in their respective areas of expertise. ... professionals, medical center staff, and management. Participates as a peer reviewer process when requested. Systematically evaluates patient care programs in all… more
- Fresenius Medical Center (Kenwood, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance ... well-being since their last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and report any unusual… more
- Fresenius Medical Center (Cincinnati, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more
- ChenMed (Cincinnati, OH)
- …visits. Once a patient has completed their episode of care management the register nurse (RN) will review patient chart for discharge and conduct final discharge ... The Intensive Community Care Manager (ICCM) is a Registered Nurse (RN) who works with our highest complexity patients,...patient needs and services available in the community or review of their benefits. + Completes individual plan of… more
- Fresenius Medical Center (Florence, KY)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more
- CenterWell (Fort Mitchell, KY)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization ... Review staff. Upon completion of the assessment, creates and...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more