- Parexel (Columbus, OH)
- …Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the ... Plan's UM Program and the review of the Plan's Utilization Management Plan. **What you will do**...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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 ... will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong… more
- CenterWell (Columbus, OH)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Sedgwick (Columbus, OH)
- …+ Apply your RN clinical knowledge and experience to provide pharmacy utilization management services to ensure safety, enhance recovery and reduce time out ... examiners regarding pharmacy issues. + Performs prospective and retrospective drug utilization management reviews. + Maintains patient privacy and… more
- Trinity Health (Columbus, OH)
- …lieu of a RN ..** **Licensure / Certification: Current license to practice as registered nurse in the State of Ohio.** ** Registered Health Information ... Specialist (CCS) will be considered in lieu of a RN .** **Experience: Minimum of 5 years acute care medical...5 years acute care medical or surgical experience required;** ** Utilization /Case Management , managed care, or Clinical Documentation… more
- Evolent (Columbus, OH)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed… more
- Centene Corporation (Columbus, OH)
- …as well as some experience in the following areas: acute care, utilization management (UM)/medical necessity review, InterQual knowledge, and discharge ... perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants (1)...and actions taken on member medical records in health management systems according to utilization management… more
- J&J Family of Companies (Columbus, OH)
- …Immunology work experience + Must be familiar with Microsoft Word, Excel, PowerPoint, and utilization of computers and remote technologies + Reside in or near ... identified OLs and health care providers (MD, PA, NP, RN , Pharm.D., biocoordinators) and developing and managing a geographical...their skills in agility, applying the competencies of Change Management , Time Management and Innovation. The MSL… more
- J&J Family of Companies (Columbus, OH)
- …TA and/or Immunology. + Must be familiar with Microsoft Word, Excel, PowerPoint, and utilization of computers and remote technologies. + Reside in or near the ... identified OLs and health care providers (MD, PA, NP, RN , Pharm.D., biocoordinators) and developing and managing a geographical...their skills in agility, applying the competencies of Change Management , Time Management and Innovation. The Sr.… more
