- Molina Healthcare (Dayton, OH)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for … more
- Bon Secours Mercy Health (Cincinnati, OH)
- …to reasonable accommodation and appropriate within the scope of practice for the registered nurse _._ Licensing/Certification RN license required in ... sites and clinicians are recognized for clinical and operational excellence. The RN Triage Specialist provides telephonic triage to assist callers to determine the… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …quality, patient safety, and performance improvement committees and projects as needed. Supports Medical Staff Quality and Peer Review . **Primary focus will be ... and clinicians are recognized for clinical and operational excellence. RN Quality Specialist Summary: Ensures the delivery of high... medical staff bylaws. Includes support of the Medical Staff Quality/Peer Review function. + Collects… more
- Insight Global (Cincinnati, OH)
- …Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Registered Nurse * 2 years experience of neuro, ... Global Health is looking for an experienced Trauma OR Nurse for one of our large Level 1 Trauma...Trauma Center clients in the Cincinnati, OH area! The Medical Center is opening brand new facility and adding… 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 ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Elevance Health (Mason, OH)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...Skills and Experiences:** + ACMP experience is preferred. + Medical Management experience is preferred, + Utilization Review… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …of Primary Function/General Purpose of Position** In the capacity of a Care Transition Nurse / Registered Nurse ( RN ), provide and facilitate coordination ... in Nursing (required) Bachelor's Degree in Nursing (BSN) (preferred) **Licensing/ Certifications:** Registered Nurse with active License in State of Patient Care… more
- Molina Healthcare (Dayton, 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...specific programs supported by the plan such as utilization review , medical claims review , long-term… more
- Molina Healthcare (Dayton, 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 ... a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Dayton, OH)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Molina Healthcare (Dayton, 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...care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours:… more
- Molina Healthcare (Dayton, 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 Care Review Clinician ( RN ) provides support for...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Dayton, OH)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Molina Healthcare (Dayton, 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 Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Dayton, 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 Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- IQVIA (Cincinnati, OH)
- Our **MedTech Registered Nurse Liaison** experiences a unique opportunity and leverage your clinical expertise in a dynamic role that goes beyond bedside care. ... with healthcare professionals and advocate for the well-being of patients through medical device technology. You will be responsible for assisting the service team… more
- Fresenius Medical Center (Cincinnati, OH)
- …task performed in the Home Therapies program under the direct supervision of the Home Therapies registered nurse (HT RN ) and in compliance with state laws. + ... information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient...obtain vital signs + Collect patient's treatment records and review for completion. Notify RN of incomplete… more
- Elevance Health (Mason, OH)
- …formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible ... ** Nurse Audit Senior - Payment Integrity Complex and...impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and… 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
- Elevance Health (Mason, OH)
- **Telephonic Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training ... different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within… more