- Centene Corporation (Columbus, OH)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... TRAVEL TO OHIO OFFICE FOR MEETINGS **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …Additional Information Note: Must have Basic Life Support (BLS) certification prior to assuming clinical duties. The BLS requirement is ... Summary The Surgery Service Float Licensed Practical Nurse (LPN), GS-7 grade level is for select,...is dependent upon the validation of competence to perform clinical procedures. Responsibilities Preferred Experience: Graduate of a school… more
- CVS Health (Columbus, OH)
- …user up front. **Required Qualifications** * 1 year UM, concurrent review or prior authorization * 5 years of clinical experience required * 5 years ... telephone queue working with providers to secure additional information for prior authorization review . CVS health requires eligible colleagues identified as… more
- Fresenius Medical Center (Westerville, 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...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- CVS Health (Columbus, OH)
- …Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. ... but are not limited to the following: + Utilizes clinical skills to coordinate, document and communicate all aspects...Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric… more
- Molina Healthcare (Columbus, OH)
- …Marketplace business. The candidate must have an RN licensure. Experience with UM medical review and prior authorization is a bonus. PEGA knowledge is highly ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- … nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting ... appointment management and the coordination of administrative information between the clinical staff and the patient. Update, and verify demographic information,… more
- Fresenius Medical Center (Westerville, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... + Monitor patients' response to dialysis therapy. + Obtain vital signs prior to reinfusion; perform all relevant functions necessary for the discontinuation of… more
- Public Consulting Group (Columbus, OH)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the… more
- Baylor Scott & White Health (Columbus, OH)
- …may vary based on position type and/or level **Job Summary** As a Registered Nurse Case Management , oversee, strategize, and monitor the team to provide quality ... to ensure quality outcomes and effective medical management through regular performance review and auditing of work products. + Represents the organization at… more