- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Highmark Health (Columbus, OH)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Columbus, OH)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- CVS Health (Columbus, OH)
- …reimbursement policy. + 1+ year of Coding experience **Preferred Qualifications** + Utilization Management review + Managed Care experience **Education** ... are 8am-5pm in time zone of residence.** **Position Summary** RN and certified coder Responsible for the review...experience required + 2+ years of experience as a Registered Nurse + Must have active, current… more
- Highmark Health (Columbus, OH)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CVS Health (Columbus, OH)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days **including ... other events, as directed by their Leader. **Required Qualifications** + Active and unrestricted Registered Nurse in state of residence + 3+ years of experience… more
- CVS Health (Columbus, OH)
- …Holiday, Weekend, and late rotations. **Required Qualifications** + Active current and unrestricted Registered Nurse in the state of residence + Willing and able ... needs require + 3+ years of experience as a Registered Nurse + 1+ years of clinical...**Critical care experience ie ICU, CCU, NICU, ER** + Utilization review experience + Managed Care experience… more
- Humana (Columbus, OH)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- CVS Health (Columbus, OH)
- …occasionally per the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- Molina Healthcare (Columbus, OH)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... review and analysis experience including clinical or case management program design._ + _Advanced experience with Microsoft applications: PowerPoint, Excel,… more
- Guardian Life (Columbus, OH)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Molina Healthcare (Columbus, OH)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… more
- Evolent (Columbus, OH)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Elevance Health (Columbus, OH)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... CST or 8am - 5pm EST** The Med Mgmt Nurse is responsible for review of the...and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate… more