- Humana (Dublin, 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… more
- Molina Healthcare (Columbus, OH)
- …Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team ... For this position we are seeking a (RN) Registered Nurse who lives in OHIO or KENTUCY and must...years of experience in case management , disease management or utilization management in… more
- Elevance Health (Columbus, OH)
- ** Utilization Management Representative II** **Location:** This is a remote position but candidates should live within 50 miles of one of our PulsePoint ... locations. The **Utilizations Management Representative II** is responsible for managing incoming calls,...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Columbus, OH)
- … management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination ... requires you to work in the office 1 - 2 times each week or minimum 1 day/week. One...miles of an Elevance Health PulsePoint . The **Medical Management Nurse Lead** will be responsible for… more
- Trinity Health (Columbus, OH)
- …of nursing plus at least four (4) years of nursing experience, including two ( 2 ) years of utilization review/case management , managed care or comparable ... **Employment Type:** Full time **Shift:** **Description:** ** Nurse Auditor, Revenue Integrity** **Position Purpose:** Responsible for...managed care. + Knowledge of and experience in case management and utilization management . +… more
- CVS Health (Columbus, OH)
- …reimbursement policy. + 1+ year of Coding experience **Preferred Qualifications** + Utilization Management review + Managed Care experience **Education** + ... Qualifications** + 5+ years of clinical experience required + 2 + years of experience as a Registered Nurse... 2 + years of experience as a Registered Nurse + Must have active, current and unrestricted RN… more
- MTC (Marion, OH)
- …the use of appropriate sanitation methods. 6. Practice basic cost containment and utilization management for patient care and facility operations. 7. Maintain ... + 401(k) retirement plan + Employee assistance program Impact lives with Management & Training Corporation (MTC)! At the **North Central Correctional Complex in… more
- CVS Health (Columbus, OH)
- …the US. Must reside in a compact state. Monday-Friday EST working 3 day shifts and 2 evening shifts a per week Evening hours end at 9:00 PM EST Rotating Saturdays ... -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits… more
- Molina Healthcare (Columbus, OH)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... and to prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2 , Quality Assurance Audit ensures mandatory reporting is completed. Conducts… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …Advanced Medical Support Assistant is responsible for the consult and scheduling management of clinics assigned across multiple facilities.This is an internal job ... the Specialty they are supporting, to review clinic appointment availability ( utilization ) to ensure that clinic schedules are closely monitored to effectively… more
- ChenMed (Columbus, OH)
- …plan of care, providing health education, specialty referrals and case management referrals, providing follow-up care and applying clear, in-depth documentation ... cardiovascular care as well as, care coordination, echocardiogram reading, population management of market's members, and oversight of PCP's cardiovascular skills. +… more