- Molina Healthcare (Columbus, OH)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level ... quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,...Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any… more
- ChenMed (Columbus, OH)
- … nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...in-depth documentation through written progress notes and summaries. The Nurse Practitioner must demonstrate the ability to function both… more
- Highmark Health (Columbus, OH)
- …Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** The Registered Nurse assesses human responses and plans, implements and evaluates nursing care ... for individuals or families for whom the nurse is responsible. The Registered Nurse is...in on-going interdisciplinary communication specific to each patient with review of patient status and plan of care. +… more
- BrightSpring Health Services (London, OH)
- …ResCare Community Living Overview Works under the supervision of a Registered Nurse . Duties include providing routine care, general observation of client's health ... care and services and reports any changes* Complete a quarterly nursing evaluation/ review of body systems on assigned individuals per program requirements. Refer to… more
- Intermountain Health (Columbus, OH)
- **Job Description:** Full Time, Monday-Friday 08:00-17:00 PST. The nurse care manager works collaboratively with physicians and other members of the health care team ... state of practice. + Two years of hospital floor clinical nursing experience and/or Nurse Care Management experience. + Able to multitask and manage quick pace, high… more
- CVS Health (Columbus, OH)
- …of residence.** **Position Summary** RN and certified coder Responsible for the review and evaluation of clinical information and documentation related to SIU ... using Internet Explorer and Google Chrome to effectively utilize review resources and conduct reviews. **Required Qualifications** + 5+...required + 2+ years of experience as a Registered Nurse + Must have active, current and unrestricted RN… more
- CVS Health (Columbus, OH)
- …is a full-time remote Utilization Management opportunity. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... in EST zone + 3+ years of clinical experience as a Registered Nurse in a hospital setting including Medical/Surgical, Emergency room, Critical Care, ICU, and/or… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Full time **Shift:** **Description:** ** Nurse Auditor, Revenue Integrity** **Position Purpose:** Responsible for coordinating denials with ... require to travel between locations within the Region. **Minimum Requirements:** + Registered Nurse and graduate of an accredited school of nursing plus at least… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Full time **Shift:** **Description:** **Position Purpose:** + The Registered Nurse will be involved with the clinical oversight of clinical work ... Welcome and room patients: heigh, weight and vitals + Review medical history chief complaints and gather other information...with a current license to practice as a Registered Nurse in the State of Ohio . Experience: One… more
- Lincoln Financial Group (Columbus, OH)
- …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 for ... for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Trinity Health (Columbus, OH)
- …and guiding behaviors, the clinical educator, within the scope of the Ohio Nurse Practice Act, functions within the standards, policies, procedures and guidelines of ... / Certification: Current licensure to practice as a registered nurse in the State of Ohio; Professional certification preferred...of Class and curriculum . Ongoing Policy and Competency review . Education plan development . Regulatory action plan… more
- Elevance Health (Columbus, OH)
- …reside within 50 miles of an Elevance Health PulsePoint . The **Medical Management Nurse Lead** will be responsible for serving as the team lead, coach, and ... improvement activities. + Assists team members, as appropriate, with review of the most challenging and complex cases, as...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of… more
- CVS Health (Columbus, OH)
- …Assessment of Members through the use of clinical tools and information/data review , conducts comprehensive evaluation of member's needs and benefit plan eligibility ... for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. **Enhancement of Medical Appropriateness & Quality of Care:**… more
- Molina Healthcare (Columbus, OH)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. To all current Molina employees: If you are interested in applying for this position, please apply through the… more
- Elevance Health (Columbus, OH)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... care. + Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for… more
- Fresenius Medical Center (Columbus, OH)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... well-being since their last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and report any unusual… more
- Fresenius Medical Center (Columbus, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more
- CVS Health (Columbus, OH)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... health needs based on key questions and conversation. **Required:** - A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a (RN) Registered Nurse who lives in OHIO or KENTUCY and must be licensed for the state they reside Clinical Auditor RN will support ... Health Plan, the role will require auditing charts of OH Health Plan care review clinicians (UM) and providing feedback and corrections to ensure the health plan… more
- Molina Healthcare (Columbus, OH)
- …and medical records to document relevant findings of a post pay clinical review . This position manages documents and prioritizes case load to ensure timely turn ... guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment… more