- Elevance Health (Cincinnati, OH)
- Nurse Utilization / Medical Management I - Medicaid (JR129062) **Location:** Candidates must reside within 50 miles or 1-hour commute each way of one of ... Friday, 8am - 5pm. EAST COAST WORK HOURS. The ** Nurse Medical Management l** is...2 years acute care clinical experience. **Preferred Qualifications:** + Utilization Management /Review experience within managed care or… more
- Elevance Health (Cincinnati, OH)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- …knowledge of internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... Summary The Cincinnati VA Medical Center is seeking 3 new Registered Nurses...of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community… more
- Molina Healthcare (Covington, KY)
- …or modification of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider ... & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of… more
- Ciena Healthcare (Hamilton, OH)
- …Medicare days and RUGs utilization in the absence of the Care Management Coordinator **Qualifications:** + Registered Nurse , RN + Knowledge of the Resident ... the industry. This includes:** + Comprehensive health insurance - medical , dental and vision + 401K with matching funds...guests under the direction and supervision of a registered nurse or a licensed practical nurse . Some… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …nurses grow, professionally and personally. **Tier 3 - System Flex Team traveler Registered Nurse (RN)** A Tier 3 - System Flex Team Traveler Registered Nurse ... through the relevant Standards and Scope of Practice for the Registered Nurse by analyzing, planning, implementing and evaluating patient care following established… more
- Molina Healthcare (Covington, KY)
- …Hearings as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies… more
- Elevance Health (Mason, OH)
- …formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical -expense spending. The ** Nurse Audit Lead** is responsible for ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...goals, policies, and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical … more
- Bon Secours Mercy Health (Cincinnati, OH)
- …operational excellence. **Summary of Primary Function/General Purpose of Position** The Registered Nurse Medical /Surgical functions as a care provider of a ... prior to direct patient care) ACLS Advanced Cardiac Life Support (preferred) Medical -Surgical Nursing Certification RN-BC (Registered Nurse - Board Certified)… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …of Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , the Ambulatory Care Manager will provide clinical care management ... Interviewing techniques as a patient-centered approach to activate patients in self- management of their chronic conditions with the goal of improved symptom… more
- Elevance Health (Cincinnati, OH)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Cincinnati, OH)
- …- 8:00pm ET The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Moon, Bundle letters, and Conditions of Participation for DC Planning and Utilization Management , and address opportunities or potential concerns with ... management , readmission prevention, supports denial prevention related to medical necessity through addressing/removing barriers to progression of care,… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based ... for professional actions * Effective stewardship of available resources * Conflict management and resilience * Authority for delegating activities to others, while… more
- ZOLL Medical Corporation (Cincinnati, OH)
- …treat patients suffering from serious cardiopulmonary and respiratory conditions.The Cardiac Management Solutions division of ZOLL Medical Corporation develops ... innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and… more
- Molina Healthcare (Covington, KY)
- … Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual ... , or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Bon Secours Mercy Health (Fairfield, OH)
- …Position** Under the direction of a Licensed Professional (eg, Physician or Registered Nurse ), the Licensed Practical Nurse (LPN) is responsible for the delivery ... The LPN complies to all documentation standards within the scope of the Medical Assistant and the LPN role. **Essential Job Functions** * Analyzes the assessment… more
- Elevance Health (Mason, OH)
- …5:00 pm.** **The Transplant Nurse II** is responsible for providing case management and/or medical management (UM/UR) for members receiving transplant ... service issues. Assists with development of utilization /care management policies and procedures. + Within the medical... management policies and procedures. + Within the medical management role will collaborate with healthcare… more
- GE Aerospace (Evendale, OH)
- …key performance indicators across safety, quality, delivery, and cost through utilization of individual and team principles of Flight Deck. **Job Description** ... their teammates. + Strong oral and written communication skills. + Excellent project management skills. + Excellent time management skills. + Master's degree in… more
- Molina Healthcare (Covington, KY)
- …to work a schedule using Pacific time zone. Previous experience working in utilization management for another MCO is preferred. This position is fully ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more