- Elevance Health (Columbus, OH)
- Nurse Utilization / Medical Management I - Medicaid (JR129062) **Location:** Candidates must reside within 50 miles or 1-hour commute each way of one of ... Friday, 8am - 5pm. EAST COAST WORK HOURS. The ** Nurse Medical Management l** is...2 years acute care clinical experience. **Preferred Qualifications:** + Utilization Management /Review experience within managed care or… more
- Humana (Columbus, OH)
- …and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- CVS Health (Columbus, OH)
- …Must possess 1+ years of clinical experience in acute or post acute setting - Utilization Management is a 24/7 operation and the work schedule may include ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- CVS Health (New Albany, OH)
- …Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... assessing, planning, implementing and coordinating all case management activities with members to evaluate the ... management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Centene Corporation (Columbus, OH)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... OF OHIO **Position Purpose:** Performs a post-service retrospective review of member medical records and assessing care related to behavioral health to determine if… more
- CVS Health (Columbus, OH)
- …in the US Hours of operation/work schedule - M-F 8:00AM-5:00PM EST. As a Utilization Management (UM) Nurse Consultant, you will utilize clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. You would be responsible...and is detail oriented and highly organized. The UM Nurse Consultant reviews services to assure medical … 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...is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and… more
- Lincoln Financial Group (Columbus, OH)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...you will provide coaching and guidance to claims regarding medical management **What you'll be doing** *… more
- Prime Therapeutics (Columbus, OH)
- …post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria. ... organizational goals through development of effective teams. + Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs. +… more
- Elevance Health (Columbus, OH)
- …Care Nurses preferred. + Prior managed care experience preferred. + Knowledge of medical management process and ability to interpret and apply member contracts, ... The Nurse Care Mgr II is responsible for collaborating...and modifies as necessary. + Assists with development of utilization /care management policies and procedures. + Participates… more
- Select Medical (Columbus, OH)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... well by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management… more
- Select Medical (Columbus, OH)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical Social Work (license per state guidelines)._ _And_ _Previous...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- CVS Health (Columbus, OH)
- …+ Promotes communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers, and health care ... special healthcare needs and carries a caseload. The Care Management Associate supports comprehensive coordination of medical ...for health care service delivery under the direction of nurse or medical director in the most… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... established criteria, as well as other approved guidelines and medical policies. Promote quality and efficiency in the delivery...Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +… more
- Trinity Health (Canal Winchester, OH)
- …time **Shift:** Night Shift **Description:** An affiliation of Mount Carmel and Fairfield Medical Center, Diley Ridge Medical Center is a state-of-the-art ... includes emergency, inpatient and diagnostic services as well as an attached medical office building. Located in Canal Winchester, the center serves patients… more
- Ciena Healthcare (Columbus, OH)
- …Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator. + Remains ... Are you an experienced MDS nurse interested in the next step? The MDS...coordination for guests. **Benefits:** + Comprehensive health insurance - medical , dental and vision. + 401K with matching funds.… more
- Trinity Health (Columbus, OH)
- …thing. **What we offer:** + Competitive compensation and benefits packages including medical , dental, and vision coverage + Retirement savings account with employer ... + Responsible for the business operations, program strategy and growth, and overall management of the FirstChoice Ohio office, to include all members of the office… more
- Sedgwick (Columbus, OH)
- …and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review. **Skills & Knowledge** + ... RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation… more
- CVS Health (Columbus, OH)
- …sharing provider performance metrics related to quality, clinical outcomes, coding, and utilization used to support OhioRISE programs. They will be a liaison between ... with a cross-functional team of clinical, analytics, provider relations and medical personnel. **Essential Functions** + Build and maintain strong professional… more