- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- Molina Healthcare (Columbus, OH)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Elevance Health (Columbus, OH)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. Preferred qualifications, skills, and experiences: + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Trinity Health (Hilliard, OH)
- …demeanor in difficult situations. . Knowledge of the functional operations of utilization management , discharge planning, business offices, and third party ... **Employment Type:** Full time **Shift:** **Description:** **Family Nurse Practitioner, Full-Time, Britton Parkway** **Position Purpose:** The APRN - Nurse … more
- Trinity Health (Columbus, OH)
- …5-7 years of clinical nursing experience with at least 2 years experience in utilization review, discharge planning, case management , or disease management ... respond to common symptoms they might experience. + Coordinates with the utilization review, case management , discharge planning staff within network facilities.… more
- Evolent (Columbus, OH)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Columbus, OH)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Elevance Health (Columbus, OH)
- …criteria._** 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 role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- CVS Health (Columbus, OH)
- …each and every day. **Position Summary** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant** to join our remote team. In this role, you will be responsible ... clinical experience. **Preferred Qualifications** + Appeals, Managed Care, or Utilization Review experience. + Pre Certification or Pre Authorization experience… more
- Molina Healthcare (Columbus, OH)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Columbus, OH)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...experience. * At least 1 year of health care management /leadership experience. * Registered Nurse (RN), Licensed… more
- Sevita (Columbus, OH)
- …team (ie, state-wide initiatives); coaches ADs on ongoing training efforts. **Financial Management :** 1. Management : Responsible for the financial performance of ... etc.; implements strategies to manage overtime. 3. Individuals' Served Funds Management : Safeguards individuals' funds and ensures compliance within region. **Census… more
- Molina Healthcare (Columbus, OH)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... For this position we are seeking a (RN) Registered Nurse or Licensed Social Worker who lives in OHIO...* Assists in implementing health management , care management , utilization management , behavioral health… more
- ChenMed (Columbus, OH)
- …We're rapidly expanding and we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving positive patient outcomes and managing ... into acute and post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing relationships with patients'… more
- ChenMed (Columbus, OH)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Molina Healthcare (Columbus, OH)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of… more
- Trinity Health (Westerville, OH)
- …or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing ... customer support to our internal and external customers, appropriate utilization of resources and patient advocacy. **Responsibilities** + Identifies discharge… more
- Trinity Health (Westerville, OH)
- …or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing ... customer support to our internal and external customers, appropriate utilization of resources and patient advocacy. **Responsibilities** + Identifies discharge… more