- Trinity Health (Columbus, OH)
- …**Description:** ** Utilization Review RN , Casual / PRN** Position Purpose: RN Utilization Review Case Mgr ensures that services are delivered ... Graduate of an accredited Registered /Professional Nursing program. * Licensure as a Registered Nurse ( RN ) in Ohio. * 3+ years of relevant clinical work… more
- AmeriHealth Caritas (Dublin, OH)
- …+ Current and unrestricted RN license in OH. + 3+ years of utilization / case management experience in relevant scope preferred, one year required. + 3+ years ... + Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS… more
- CVS Health (New Albany, OH)
- …3 months. Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for ... telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to… more
- CenterWell (Mount Vernon, OH)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Prime Therapeutics (Columbus, OH)
- …oversight for this program is provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse ( RN ). + 5 years of post-degree clinical ... Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria....- Preferred: Bachelors - Nursing **Certifications** Certifications - Required: RN - Registered Nurse , State… more
- CVS Health (Lewis Center, OH)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... or changes in condition to be transitioned back to RN . + Complete post discharge call and required assessments...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more