- Elevance Health (Mason, OH)
- …not be considered for employment, unless an accommodation is granted as required by law. The ** Lead Clinical Review Nurse ** is responsible for serving as ... in a cost effective setting according to contract. + Consults with clinical reviewers and/or medical directors to ensure appropriate coding assignment. +… more
- Elevance Health (Cincinnati, OH)
- ** Nurse Appeals -Licensed Nurse ** **Location** :...Review requests. .Acts as a resource for both clinical and non- clinical teams, by managing and ... hours will be necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical necessity appeals… 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 care management...health related field and minimum of 5 years of clinical experience; or any combination of education and experience,… more
- Elevance Health (Cincinnati, OH)
- ** Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ **Virtual:** ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals** is responsible for investigating and processing and medical necessity… more
- Deloitte (Cincinnati, OH)
- … registered nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG ... lead to coding accuracy + Identify gaps in clinical documentation and request missing information from the appropriate...medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical … more
- Elevance Health (Mason, OH)
- **Telephonic Nurse Case Manager I** **Sign on Bonus: $3000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
- ChenMed (Cincinnati, OH)
- …their healthy time at home. The Intensive Community Managers (ICCMs) will serve as a clinical lead for the Complex Care Team. They will assess, evaluate, and ... has completed their episode of care management the register nurse (RN) will review patient chart for...clinical field preferred + A valid, active Registered Nurse (RN) license in State of employment required. Compact… more
- Molina Healthcare (Cincinnati, OH)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + ... the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the… more
- Elevance Health (Mason, OH)
- …+ HS diploma or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Mercy Health** **_About Us_** As a faith-based ... life threatening changes from "slow evolving" changes. Appropriately notifies/pages charge nurse or designate of witnessed changes. Documents changes for review… more