- Molina Healthcare (Covington, KY)
- …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
- 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)
- …the Elevance Health major office (PulsePoint) location listed above. The **Medical Management Nurse ** is responsible for review of the most complex or ... **Medical Management Nurse ** **Office Location** : Atlanta, GA; Indianapolis, IN;...and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of… more
- Insight Global (Cincinnati, OH)
- Job Description Insight Global Health is looking for an experienced Trauma OR Nurse for one of our large Level 1 Trauma Center clients in the Cincinnati, OH area! ... brand new facility and adding 8 new operating rooms. This Trauma OR Nurse will be responsible for providing high-level emergency care to patients suffering from… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …excellence. **Summary of Primary Function** In the capacity of a Registered Nurse , the Ambulatory Care Manager will provide clinical care management services to ... care plans to maximize healthcare outcomes and facilitate wellness with periodic review and update according to department protocols. + Perform medication review… more
- Fresenius Medical Center (Florence, KY)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...Assessment physical. + Ensures completion of Annual Standing Order Review with each physician as required. **OTHER:** + As… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- CommuniCare Health Services Corporate (Cincinnati, OH)
- 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 ... + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization, errors, assessments and accurate… more
- Molina Healthcare (Covington, KY)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other specific program… more
- Insight Global (Cincinnati, OH)
- …shifts ONLY -13 week contract with extension possibilities Job Responsibilities The Registered Nurse is an individual who holds a current state license to practice ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Insight Global (Cincinnati, OH)
- …team strives to create a supportive, team-oriented environment. Responsibilities The Registered Nurse (RN) is an individual who holds a current state license to ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Bon Secours Mercy Health (Green Township, OH)
- …committees and projects as needed. + Supports Medical Staff Quality and Peer Review . + Promotes practices that detect, mitigate or prevent harm using highly reliable ... reporting obligations using data analytics and analysis + Facilitates provider performance review activities through the peer review , ongoing and focused… more
- Bon Secours Mercy Health (Batavia, OH)
- …using NHSN criteria, documentation, and investigation of HAI through review of admission diagnoses, laboratory results, isolation, patient records, consultation ... requests, post-discharge surveillance, and autopsy findings + Utilizes computer-based programs for tracking, reporting and disseminating information from surveillance activities. Prepares statistical reports utilizing epidemiologic principles to identify and… 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)
- **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_2 openings for 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 ... days a week will rotate._** **_TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift after training is completed. Training hours are mandatory._** **_This position… more
- Molina Healthcare (Covington, KY)
- …job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in Nursing. **OR** ... Bachelor's Degree in a social science, psychology, counseling, gerontology, public health, social work, or health related field. **OR** LVN/LPN with an additional 4 years of related experience in lieu of a Bachelor's Degree **REQUIRED EXPERIENCE/KNOWLEDGE,… more
- Molina Healthcare (Covington, KY)
- …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. **Preferred Experience** Previous experience in hospital Acute care, ER or ICU Previous experience with InterQual… more
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- …the section (if appropriate), as needed. Provides guidance and support to the nurse practitioners assigned to Medical Service in their respective areas of expertise. ... professionals, medical center staff, and management. Participates as a peer reviewer process when requested. Systematically evaluates patient care programs in all… more
- Fresenius Medical Center (Florence, KY)
- …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
- GE Aerospace (Evendale, OH)
- …with support of key stakeholders (HQ Functions, Controllership, Corp Holdings + Review Group FP&A calendar and prepare initial design of the Corporate financial ... calendar for review by Corporate FP&A and Allocations Leader + Prepare...drug coverage; access to a Health Coach, a 24/7 nurse -based resource; and access to the Employee Assistance Program,… more