- Molina Healthcare (Cincinnati, OH)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level ... quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,...Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any… more
- Gentiva (Cincinnati, OH)
- …care for everyone, so we offer ongoing professional training, lower nurse -to-patient ratios, and comprehensive benefits for eligible employees. Here, you'll join ... difference in people's lives every day. **Overview** We're looking for a **Hospice Nurse Practitioner** to join our team.You will report directly to the Executive… more
- Insight Global (Cincinnati, OH)
- Job Description Insight Global Health is looking for an experienced Trauma OR Nurse for one of our large Level 1 Trauma Center clients in the Cincinnati, OH area! ... brand new facility and adding 8 new operating rooms. This Trauma OR Nurse will be responsible for providing high-level emergency care to patients suffering from… more
- Humana (Fort Thomas, KY)
- …that supports the goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for appropriate care ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN, Intern will utilize Humana's Medicaid training and engage formerly… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , the Ambulatory Care Manager will provide clinical care management services to ... care plans to maximize healthcare outcomes and facilitate wellness with periodic review and update according to department protocols. + Perform medication review… more
- CommuniCare Health Services Corporate (Cincinnati, OH)
- Registered Nurse (RN), Mobile MDS Coordinator CommuniCare Health Services is currently looking for a Registered Nurse to fill the key position of RN Mobile MDS ... + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization, errors, assessments and accurate… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …workflows. + Participates in process improvement, professional development and peer review + Maintains active RN licensure within the states transfer center ... their supervisor, subject to reasonable accommodation. Licensing/Certification Active Registered Nurse (RN) - Required Active multistate/compact registered nurse … more
- Elevance Health (Cincinnati, OH)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
- Elevance Health (Mason, OH)
- ** Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Fresenius Medical Center (Connersville, IN)
- …therapy for assigned patients under the direct supervision of a registered nurse . Participates in the implementation and evaluation of patient care. Responsible for ... intravenous medication in accordance with physician orders and state nurse practice laws. + Perform and document pre, interim,...+ Perform and document pre, interim, and post treatment review of patient condition. + Initiate basic CPR measures… more
- Elevance Health (Cincinnati, OH)
- …reside within 50 miles of an Elevance Health PulsePoint . The **Medical Management Nurse Lead** will be responsible for serving as the team lead, coach, and ... improvement activities. + Assists team members, as appropriate, with review of the most challenging and complex cases, as...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of… more
- Insight Global (Cincinnati, OH)
- …team strives to create a supportive, team-oriented environment. Responsibilities The Registered Nurse (RN) is an individual who holds a current state license to ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Insight Global (Cincinnati, OH)
- …shifts ONLY -13 week contract with extension possibilities Job Responsibilities The Registered Nurse is an individual who holds a current state license to practice ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **_For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization ... Review / Utilization Management and knowledge of Interqual / MCG guidelines. WI or COMPACT RN LICENSURE IS REQUIRED within 30 days of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is… more
- Molina Healthcare (Cincinnati, OH)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. **Preferred Experience** Previous experience in hospital Acute care, ER or ICU Previous experience with InterQual… more
- Elevance Health (Cincinnati, OH)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... care. + Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for… more
- GE Aerospace (Evendale, OH)
- …efforts of assigned projects and/or tasks + Participate as a presenter or reviewer in technical and program reviews + Interpret and clarify customer technical ... and prescription drug coverage; access to a Health Coach, a 24/7 nurse -based resource; and access to the Employee Assistance Program, providing 24/7 confidential… more
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- …the section (if appropriate), as needed. Provides guidance and support to the nurse practitioners assigned to Medical Service in their respective areas of expertise. ... professionals, medical center staff, and management. Participates as a peer reviewer process when requested. Systematically evaluates patient care programs in all… more
- Fresenius Medical Center (Kenwood, OH)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance ... well-being since their last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and report any unusual… more
- Fresenius Medical Center (Florence, KY)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… more