• Medical Claim Review Nurse (RN)

    Molina Healthcare (Dayton, 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
    Molina Healthcare (01/25/25)
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  • Associate Clinical Nurse Editor, eLearning

    RELX INC (Dayton, OH)
    Associate Clinical Nurse Editor, eLearning Do you excel in validating the clinical accuracy and relevance of point-of-care and educational materials? Would you excel ... integration into content About the role The Associate Clinical Nurse Editor for eLearning plays a key role in...eLearning plays a key role in supporting the development, review , and maintenance of multimedia nursing, allied health, and… more
    RELX INC (02/07/25)
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  • Delegation Oversight Nurse (Must Reside…

    Molina Healthcare (Dayton, OH)
    …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
    Molina Healthcare (03/06/25)
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  • Practical Nurse

    Veterans Affairs, Veterans Health Administration (Dayton, OH)
    Summary The Dayton VA Medical Center is seeking a Licensed Practical Nurse (LPN) to join the Kennedy Way Department within the Community Living Center (CLC). The LPN ... replacement has been done by the physician or registered nurse . Initiates IV Therapy (Must have an Ohio Board...completed work may require routine or detailed higher level review depending upon the complexity of the duties involved.… more
    Veterans Affairs, Veterans Health Administration (03/14/25)
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  • Nurse Practitioner

    Gentiva (Dayton, 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
    Gentiva (02/11/25)
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  • Clinical Trials Research Nurse

    Premier Health (Centerville, OH)
    …The Research Nurse is responsible for providing expertise in the review and implementation of clinical trials for patients, who are eligible and desire ... to participate. The Research Nurse is responsible to assess the patient's eligibility per...departments, physician offices and national external facilities. The research nurse performs quality data collection and submits it for… more
    Premier Health (02/15/25)
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  • Practical Nurse

    Veterans Affairs, Veterans Health Administration (Dayton, OH)
    Summary The Dayton VA Medical Center is looking for a Licensed Practical Nurse (LPN) to join their Primary Care team. The LPN provides nursing care, requiring the ... duties include but not limited to: Notifies supervisory staff nurse and/or supervisor of any problems or changes in...completed work may require routine or detailed higher level review depending upon the complexity of the duties involved.… more
    Veterans Affairs, Veterans Health Administration (03/12/25)
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  • Practical Nurse - Primary Care Middletown…

    Veterans Affairs, Veterans Health Administration (Middletown, OH)
    Summary The Dayton VAMC is seeking a Licensed Practical Nurse (LPN) to join our Primary Care clinical team in Middletown, Ohio. The LPN will participate and provide ... other duties as assigned VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4 Total-Rewards-of-an-Allied-Health-VA-Career-Brochure.pdf Licensed Practical Nurse -… more
    Veterans Affairs, Veterans Health Administration (03/12/25)
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  • New Graduate Registered Nurse

    Fresenius Medical Center (Centerville, OH)
    …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...Assessment physical. + Ensures completion of Annual Standing Order Review with each physician as required. **OTHER:** + As… more
    Fresenius Medical Center (02/14/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Mason, OH)
    **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Ideal candidates will reside within 50 miles of an Elevance Health Pulse Point ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the… more
    Elevance Health (03/13/25)
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  • Nurse Manager

    Insight Global (Dayton, OH)
    Job Description Insight Global is seeking a Nurse Manager for a direct placement opportunity in Dayton, Ohio. This candidates will have 25 direct reports including ... 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 (12/31/24)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Dayton, OH)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other specific program… more
    Molina Healthcare (02/09/25)
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  • Nurse Navigator/ Research -Pulmonary

    Dayton Children's Hospital (Dayton, OH)
    …regulatory activities. Responsible for regulatory document attainment and Institutional Review Board submissions, recruitment and enrollment of study participants, ... Nursing (Required), Bachelors: Nursing Certification/License Requirements: [Lic] RN: Registered Nurse (RN) - Ohio Board of Nursing, CPR: Cardio-Pulmonary… more
    Dayton Children's Hospital (03/04/25)
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  • Care Review Clinician, PA (RN) - Transplant…

    Molina Healthcare (Dayton, OH)
    **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be given to those… more
    Molina Healthcare (03/07/25)
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  • Inpatient Review (RN): Remote, California…

    Molina Healthcare (Dayton, OH)
    **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_2 openings for 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 ... days a week will rotate._** **_TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift after training is completed. Training hours are mandatory._** **_This position… more
    Molina Healthcare (02/14/25)
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  • Trainer - Clinical Services - Utilization…

    Molina Healthcare (Dayton, OH)
    …job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in Nursing. **OR** ... Bachelor's Degree in a social science, psychology, counseling, gerontology, public health, social work, or health related field. **OR** LVN/LPN with an additional 4 years of related experience in lieu of a Bachelor's Degree **REQUIRED EXPERIENCE/KNOWLEDGE,… more
    Molina Healthcare (03/13/25)
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  • Care Review Clinician, Prior Auth (RN)

    Molina Healthcare (Dayton, 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
    Molina Healthcare (01/21/25)
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  • Manager, Healthcare Services (Remote)

    Molina Healthcare (Dayton, OH)
    …performing one or more of the following activities: care review /utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case ... opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational Nurse more
    Molina Healthcare (03/07/25)
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  • Medical Social Worker

    Premier Health (Middletown, OH)
    …☐ Not Applicable **Organizational Standards** | Work in conjunction with nurse navigator on intake assessment including social needs/barrier identification of ... referred and enrolled in the program; determine plan for care with nurse navigator; responsible for management and completion of social/behavioral tasks for each… more
    Premier Health (02/06/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Dayton, OH)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
    Molina Healthcare (02/06/25)
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