- Elevance Health (Mason, OH)
- ** Clinical Review Nurse I - Medicare Part A** **Location:** This role enables associates to work virtually full-time, with the exception of required ... for Medicare and Medicaid Services to transform federal health programs. The ** Clinical Review Nurse I** is responsible for reviewing and making medical… more
- Molina Healthcare (Covington, KY)
- …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… more
- Elevance Health (Cincinnati, OH)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Elevance Health (Mason, OH)
- ** Nurse Reviewer I** **Location:** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training sessions, ... integration, and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out… more
- Molina Healthcare (Covington, KY)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience,… 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 ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience,… more
- CommuniCare Health Services Corporate (Cincinnati, OH)
- …+ Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization, errors, assessments and ... Registered Nurse (RN), Mobile MDS Coordinator CommuniCare Health Services is currently looking for a Registered Nurse to fill the key position of RN Mobile MDS… more
- Adecco US, Inc. (Milford, OH)
- …Requires an RN with unrestricted active license Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred ... Adecco is recruiting for a Nurse Case Manager for a national health care company in Ohio Looking in: Hamilton, Butler, Clermont, or Warren Counties. Remote but will… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of ... Position** The Medical Assistant Certified is a multi-skilled clinical professional that provides indirect and/or direct patient care within the scope of practice… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of ... Position** The Medical Assistant is a multi-skilled clinical professional that provides indirect and/or direct patient care within the scope of practice and in… more
- Select Medical (Fort Thomas, KY)
- …highly effective level of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse (RN) or Respiratory ... other designations like LPN, PT, OT etc., upon further review . + Ability to complete clinical assessments...upon further review . + Ability to complete clinical assessments of medically complex patients. **Preferred skills that… more
- Elevance Health (Mason, OH)
- **Diagnosis Related Group Clinical Validation Auditor-RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... face-to-face onboarding and skill development. The **Diagnosis Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records… more
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who must have a RN OHIO license, or compact RN license The Care Review Clinician ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be given to those… more
- Molina Healthcare (Covington, KY)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... in consistent and efficient manner. + Makes appropriate referrals to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …the clinical advancement program. Serves as the administrative liaison for the nurse clinical advancement program under the guidance of site/market CNO and ... programmatic, and personnel activities as it related to Nursing Excellence, Magnet(R), and nurse -sensitive clinical outcomes. This role serves as a culture and… more
- HCA Healthcare (Cincinnati, OH)
- …in Nursing (BSN) Degree + Experiential Qualifications: Minimum of two (2) years of clinical experience as a Registered Nurse and per State Board of Nursing ... are currently looking for an ambitious Nursing Faculty - Clinical to help us reach our goals. Unlock your...effectively in the healthcare environment. 4. Participates in the review of the curriculum to ensure integrity, rigor, and… more
- Fresenius Medical Center (Milford, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Molina Healthcare (Covington, KY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more