- Evolent (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- CVS Health (Columbus, OH)
- …lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital ... to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical ...referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and… more
- Fresenius Medical Center (Columbus, OH)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- OhioHealth (Columbus, OH)
- …Duties:** 1. 25% Screens and processes donors to include phone calls, sending packets, review completed packet, obtain medical release for donor and her baby, ... careers and in our communities. **Job Description Summary:** The Clinical Coordinator supports the day to day operations of...facilitates lab work with results review and transfer of milk to a collection site… more
- Gentiva (Columbus, OH)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- CenterWell (Columbus, OH)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- Elevance Health (Columbus, OH)
- …legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. .Acts as a resource for both clinical ... ** Nurse Appeals -Licensed Nurse ** **Location** :...accurate entry, investigation, and analysis of state appeals; summarizing medical information for review by medical… more
- Trinity Health (Columbus, OH)
- …clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer , educator and consultant. ... Facilitates the overall quality, completeness, accuracy, and integrity of medical record documentation through extensive record review . Through extensive… more
- Elevance Health (Columbus, OH)
- … necessity. + Extrapolates and summarizes medical information for medical director, consultants and other external review . + Prepares recommendations ... ** Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason,... Appeals** is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How… more
- OhioHealth (Columbus, OH)
- …to provide care to neuro patients. You will provide patient education support, review medical history and provide surgery follow-up care. In addition, you ... will use your clinical expertise to address triage and medical ...personnel (UAPs) using the criteria written in the Ohio Nurse Practice Act. According to department policies and nursing… more
- Datavant (Columbus, OH)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Highmark Health (Columbus, OH)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... Preferred + Associate's or Bachelor's Degree in Nursing + 1 year performing medical record review and data abstraction for cardiovascular registries + Proficient… more
- Surgery Care Affiliates (Dublin, OH)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Humana (Columbus, OH)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- CenterWell (Columbus, OH)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Select Medical (Columbus, OH)
- …of medical rehabilitation. They assess patients to determine individual care needs, review medical records, and meet with hospital teams to coordinate safe ... **Overview** **Ohio Health Rehabilitation Hospital** A joint venture with Select Medical & Hospital Columbus, OH **Annual Base Salary between $70,000 and $95,000**… more
- Insight Global (Gahanna, OH)
- …a safe, high-quality care environment. Key responsibilities include: * Overseeing all clinical aspects of hospice care, including chart review , onboarding of ... Active Registered Nurse (RN) license Minimum 3 years of hospice clinical experience (2 years may be considered if combined with management experience) At… more
- Oracle (Columbus, OH)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- CVS Health (Columbus, OH)
- …Ability to obtain licensure in non-compact states as needed. + 5+ years of clinical practice experience in medical healthcare. + 2+ year's managed care ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Molina Healthcare (Columbus, OH)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more