- Cognizant (Columbus, OH)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Communities is good for the Soul. Join Us!** The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Columbus, OH)
- …varying hours available with Holiday, Weekend, and late rotations. **Required Qualifications** + Registered Nurse + Must have active current and unrestricted RN ... it all with heart, each and every day. **Position Summary** + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… 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 ... but are not limited to the following: + Utilizes clinical skills to coordinate, document and communicate all aspects...Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN… more
- CVS Health (Columbus, OH)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… 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 ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… more
- 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… 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 ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses... clinical experience in an acute care setting. **This role… more
- Humana (Columbus, OH)
- …Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **(RN)** or other professional license. + Three (3) ... health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health knowledge and… more
- OhioHealth (Columbus, OH)
- …Heart Association, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job Description:** Current ... careers and in our communities. **Job Description Summary:** The RN Clinical Leader provides leadership and coordinates the design, development, implementation and… more
- Molina Healthcare (Columbus, OH)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....or modification of payment decisions. * Serves as a clinical resource for utilization management, chief medical… more
- Lincoln Financial (Columbus, OH)
- …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible… more
- Molina Healthcare (Columbus, OH)
- …driver's license **PREFERRED EDUCATION:** **PREFERRED EXPERIENCE:** + 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a ... **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary... Practitioner will be required to work primarily in non- clinical settings and provide medical care to all levels… more
- Molina Healthcare (Columbus, OH)
- …and electronic medical record (EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, ... primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing… more
- Molina Healthcare (Columbus, OH)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Molina Healthcare (Columbus, OH)
- …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active and unrestricted ... least 3 years management/leadership experience in a clinical leadership, clinical systems and/or informatics, utilization management, or care management… more
- Molina Healthcare (Columbus, OH)
- …behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- Molina Healthcare (Columbus, OH)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Trinity Health (Canal Winchester, OH)
- …with the mission of Diley Ridge Medical Center, under the direction of a Registered Nurse , the Multi-skilled Technician, will provide direct and indirect patient ... required. Exhibits a community and customer service focus. Job Relationships Reports to: Assistant Clinical Manager, Clinical Nurse Manager, Charge Nurse … more
- Gentiva (Columbus, OH)
- …Administrator to join our leadership team. This role is ideal for a licensed Registered Nurse (RN) with strong leadership experience in hospice care, home ... health, or clinical operations management. If you're a natural leader who...growth through census development, referral management, and efficient resource utilization + Maintain strong relationships with physicians, referral sources,… more