- CVS Health (Columbus, OH)
- …**Required Qualifications:** -3+ Years of clinical experience -1+ Year of Utilization Review Management and/or Medical Management ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases . Applies the appropriate clinical criteria/guideline to render a… more
- CVS Health (Columbus, OH)
- …other internal and external constituents in the coordination and administration of the utilization /benefit management function. + UM Nurse Consultant meets ... Friday 8:00am to 5pm in time zone of residence. Utilization Management is a 24/7 operation and...Critical care experience ie ICU, CCU, NICU, ER + Utilization review experience + Managed Care experience… more
- CVS Health (Columbus, OH)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days **including ... and UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience in ER, triage, ICU,… 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,...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Molina Healthcare (Columbus, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- ChenMed (Columbus, OH)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Trinity Health (Columbus, OH)
- …at least four (4) years of nursing experience, including two (2) years of utilization review /case management , managed care or comparable patient payment ... **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
- Evolent (Columbus, OH)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. **Position Summary** The Care Management Associate (CMA) role is a full-time remote telework position. Qualified ... with special healthcare needs and carries a caseload. The Care Management Associate supports comprehensive coordination of medical services including Care Team… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …current administrative guidelines. The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic ... of judgment, fact-finding, and coordination with people at various levels (patients, management , VISN). Additional duties or tasks may be assigned by the supervisor… more
- Molina Healthcare (Columbus, OH)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more