- CVS Health (Columbus, OH)
- …**Required Qualifications:** -3+ Years of clinical experience -1+ Year of Utilization Review Management and/or Medical Management ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases . Applies the appropriate clinical criteria/guideline to render a… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Columbus, OH)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Highmark Health (Columbus, OH)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Columbus, OH)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- CVS Health (Columbus, OH)
- …reimbursement policy. + 1+ year of Coding experience **Preferred Qualifications** + Utilization Management review + Managed Care experience **Education** ... are 8am-5pm in time zone of residence.** **Position Summary** RN and certified coder Responsible for the review...experience required + 2+ years of experience as a Registered Nurse + Must have active, current… more
- Highmark Health (Columbus, OH)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CVS Health (Columbus, OH)
- …This is a full-time remote Utilization Management opportunity. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... zone + 3+ years of clinical experience as a Registered Nurse in a hospital setting including...of clinical experience in acute or post-acute setting + Utilization management is a 24/7 operation. Work… more
- CVS Health (Columbus, OH)
- …Holiday, Weekend, and late rotations. **Required Qualifications** + Active current and unrestricted Registered Nurse in the state of residence + Willing and able ... needs require + 3+ years of experience as a Registered Nurse + 1+ years of clinical...**Critical care experience ie ICU, CCU, NICU, ER** + Utilization review experience + Managed Care experience… 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 ... first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday. + A Registered Nurse that must hold an unrestricted license in their state… more
- Humana (Columbus, OH)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- Molina Healthcare (Columbus, OH)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Guardian Life (Columbus, OH)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Molina Healthcare (Columbus, OH)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… more
- Fresenius Medical Center (Columbus, OH)
- …meetings may be required. **SUPERVISION:** **None** **EDUCATION AND REQUIRED CREDENTIALS:** * Registered Nurse required *Certification in Nephrology Nursing or ... barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing Orders, clinical… more