- 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,...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …and guidelines. Responsibilities Preferred Experience: 1- 2 years of case management experience preferred The Nurse Oncology/Hematology Registered Nurse ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN… more
- Trinity Health (Columbus, OH)
- …of nursing plus at least four (4) years of nursing experience, including two ( 2 ) years of utilization review/case management , managed care or comparable ... **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
- 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
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... and to prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2 , Quality Assurance Audit ensures mandatory reporting is completed. Conducts… more
- Trinity Health (Canal Winchester, OH)
- …Job Relationships Reports to: Clinical Manager, Assistant Clinical Manager/Educator, Charge Nurse or designee Supervises: N / A Job Responsibilities Essential ... therapy, arterial blood gases, non-invasive monitoring, etc. . Performs critical care patient management , to include: ventilator management , Code Blue / ACLS … more
- ChenMed (Columbus, OH)
- …plan of care, providing health education, specialty referrals and case management referrals, providing follow-up care and applying clear, in-depth documentation ... cardiovascular care as well as, care coordination, echocardiogram reading, population management of market's members, and oversight of PCP's cardiovascular skills. +… more
- Humana (Columbus, OH)
- …professional development. Training programs may include, but not be limited to, Care Management , Utilization Management , and/or Compliance. RN licensure is ... with a focus on nursing education. + Licensed Registered Nurse (RN) in the state where you reside with...+ 5 years or more of clinical experience + 2 years of experience educating nurses + Knowledge of… more