- Cognizant (Columbus, OH)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Molina Healthcare (Columbus, OH)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- Evolent (Columbus, OH)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- OhioHealth (Pickerington, OH)
- …Heart Association, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job Description:** Current ... careers and in our communities. **Job Description Summary:** The RN Clinical Leader provides leadership and coordinates the design, development, implementation and… more
- Trinity Health (Columbus, OH)
- …considered in lieu of an RN. + Licensure/Certification: Current license to practice as registered nurse in the State of Ohio. Registered Health Information ... Minimum of 5 years acute care medical or surgical experience required; Utilization /Case Management, managed care, or Clinical Documentation and experience in… more
- Molina Healthcare (Columbus, OH)
- …and experience. * At least 5 years health care management/leadership required. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical ... * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active and unrestricted… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Trinity Health (Grove City, OH)
- …+ Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years' recent ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses...to readmit to the hospital. + Assures all appropriate clinical information is provided to outside agencies. + Communicates… more
- Trinity Health (Westerville, OH)
- …for:** + Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… more
- Trinity Health (Westerville, OH)
- …for:** + Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients,… more
- Trinity Health (Westerville, OH)
- …+ Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Trinity Health (Canal Winchester, OH)
- …with the mission of Diley Ridge Medical Center, under the direction of a Registered Nurse , the Multi-skilled Technician, will provide direct and indirect patient ... service focus. **Job Relationships** _Reports to:_ Clinical Manager, Assistant Clinical Manager/Educator, Charge Nurse or designee _Supervises:_ N /A **Job… more
- Highmark Health (Columbus, OH)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Gentiva (Circleville, OH)
- …Director to join our leadership team. This role is ideal for a licensed Registered Nurse (RN) with strong leadership experience in hospice care, home health, ... or clinical operations management. If you're a natural leader who...growth through census development, referral management, and efficient resource utilization + Maintain strong relationships with physicians, referral sources,… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- OhioHealth (Columbus, OH)
- …And Duties:** **Minimum Qualifications:** Bachelor's Degree (Required)APRN - Advanced Practice Registered Nurse License - State of Ohio Board of ... Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing...Computer skill and data entry. Knowledge and skill in clinical assessment and disease management. BLS issued by American… more
- Trinity Health (Columbus, OH)
- …school of nursing. Baccalaureate degree strongly desired. + Current license to practice as a Registered Nurse in State of Ohio. + Minimum of four to five years ... recent clinical experience in hospital setting with Care Manager/Charge Nurse or other relevant hospital management experience required. + Demonstrates results… more