- 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...to make an impact** **Required Qualifications** + Active enhanced Registered Nurse , (eNLC) license (RN) with no… 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 ... current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... weeks on camera training required 100% participation during 8:30am-5pm Monday-Friday. * A Registered Nurse that must hold an unrestricted license in their state… more
- CVS Health (Columbus, OH)
- …and every day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out ... to hold a Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted state license in Ohio, and travel up… more
- CVS Health (Columbus, OH)
- …+ Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse (RN) with at least 1...or Specialty Pharmacy.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Sharecare (Columbus, OH)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting...disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations… more
- Option Care Health (Columbus, OH)
- …and/or Experience Requirements:** + Graduate of an accredited school of nursing + Current Registered Nurse (RN) licensure in the state of practice + 5 years ... orders regarding patient care that relate to telephonic nursing support and management . + Provide excellent communication to nurse colleagues regarding patients… more
- Trinity Health (Columbus, OH)
- …Degree in Nursing + Licensure / Certification: Current license to practice as a Registered Nurse in their home state or hold a compact nursing license. ... and at the direction of the Sr. Director of Medical Management . + Coordinates with the utilization review, case management , discharge planning staff within… more
- Fresenius Medical Center (Westerville, OH)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Evolent (Columbus, OH)
- … Management Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Battelle Memorial Institute (Columbus, OH)
- …, critical care or a related area is required. + Licensure to practice as a Registered Nurse in Ohio is required. + Must be capable of using respiratory ... experiences and welcome all qualified individuals to apply. **Job Summary** The nurse provides clinical and administrative support for the operation of a… more
- Molina Healthcare (Columbus, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who be licensed in the state they reside. We are looking for a RN Supervisor to ... manage a utilization management team supporting 14 Marketplace plans....skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing (RN) in good standing. + Must have… more
- United Therapeutics (Columbus, OH)
- …years of PAH nursing experience, including ICU and critical care of PAH patients + Registered Nurse (RN) - State Licensure and/or Compact State Licensure RN - ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...Registered Nurse - State Licensure and/or Compact… more
- Trinity Health (Columbus, OH)
- …or Master's Degree preferred . Licensure / Certification: Current license to practice as a registered nurse in the State of Ohio . Experience: Minimum of five ... demeanor in difficult situations . Knowledge of the functional operations of utilization management , discharge planning, business office and third party payers… more
- Select Medical (Columbus, OH)
- …of acute transfers and other CQI indicators. **Qualifications** **Minimum Qualifications** + Registered Nurse with valid state license. Legacy employees may ... with Select Medical & OhioHealth Columbus, OH **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical Quality … more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse (RN) license + Delaware RN...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… 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 (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 ... or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing… more