- CVS Health (Columbus, OH)
- …schedule may include weekends, holidays and evening hours._ This is a full-time remote Utilization Management opportunity. + Utilizes clinical experience and ... zone + 3+ years of clinical experience as a Registered Nurse in a hospital setting including...with a late shift rotation 10:30am to 7pm EST. Utilization management is a 24/7 operation. Work… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a ( RN ) Registered Nurse who lives in OHIO or KENTUCY and must be licensed for the state they reside Clinical Auditor RN ... **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization ... nurse and other clinical functions in Utilization Management (UM), Case Management … more
- Humana (Columbus, OH)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- Highmark Health (Columbus, OH)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Guardian Life (Columbus, OH)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- AmeriHealth Caritas (Dublin, OH)
- …complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- CVS Health (Columbus, OH)
- …+ 5+ years of clinical experience required + 2+ years of experience as a Registered Nurse + Must have active, current and unrestricted RN licensure ... reimbursement policy. + 1+ year of Coding experience **Preferred Qualifications** + Utilization Management review + Managed Care experience **Education** +… 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
- Humana (Columbus, OH)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more