- 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Columbus, OH)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Molina Healthcare (Columbus, OH)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… 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, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Trinity Health (Columbus, OH)
- …obtain licenses from other participating states + Experience: Minimum of 5-7 years of clinical nursing experience with at least 2 years experience in utilization ... preferred. + Demonstrated ability to analyze, summarize and concisely report medical utilization , and medical chart audit results. + Ability to compare approved… more
- OhioHealth (Columbus, OH)
- …Heart Association, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job Description:** Current ... careers and in our communities. **Job Description Summary:** The RN Clinical Leader provides leadership and coordinates the design, development, implementation and… more
- Molina Healthcare (Columbus, OH)
- …experience. * At least 1 year of health care management/leadership experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical ... Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist...Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION For this position we are seeking a (RN) Registered Nurse or Licensed Social Worker who lives in OHIO and must be licensed for the state of OHIO. ... r equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational Nurse...(RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW),… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Trinity Health (Westerville, OH)
- …+ Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years' recent ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses...to readmit to the hospital. + Assures all appropriate clinical information is provided to outside agencies. + Communicates… more
- Trinity Health (Westerville, OH)
- …+ Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing… more
- Trinity Health (Westerville, OH)
- …for:** + Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… more
- Trinity Health (Westerville, OH)
- …for:** + Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… 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 connectivity of ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Highmark Health (Columbus, OH)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- OhioHealth (Columbus, OH)
- …And Duties:** **Minimum Qualifications:** Bachelor's Degree (Required)APRN - Advanced Practice Registered Nurse License - State of Ohio Board of ... Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing...Computer skill and data entry. Knowledge and skill in clinical assessment and disease management. BLS issued by American… more
- Trinity Health (Columbus, OH)
- …school of nursing. Baccalaureate degree strongly desired. + Current license to practice as a Registered Nurse in State of Ohio. + Minimum of four to five years ... recent clinical experience in hospital setting with Care Manager/Charge Nurse or other relevant hospital management experience required. + Demonstrates results… more
- Select Medical (Dublin, OH)
- …Current Licensure in a clinical discipline per state guidelines required. ( Registered Nurse or Social Work (SW) preferred) **Preferred Qualifications** + ... the allotted time frame; assuring payments of services meeting patient-related utilization management criteria, and implementation of safe and appropriate discharge… more