- Molina Healthcare (Cleveland, OH)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
- CommuniCare Health Services Corporate (Cleveland, OH)
- … + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization , errors, assessments and ... Registered Nurse (RN), Mobile MDS Coordinator CommuniCare Health Services is currently looking for a Registered Nurse to fill the key position of RN Mobile MDS… more
- Fresenius Medical Center (Akron, OH)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Molina Healthcare (Cleveland, OH)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Cleveland Clinic (Cleveland, OH)
- …will work closely with surgical operations to assure the most effective utilization of anesthesiology services at all Cleveland Clinic locations in northeast Ohio. ... with staff anesthesiologists medically directing residents, fellows, certified registered nurse anesthetists, and certified anesthesiologist assistants. The mission of… more
- MetroHealth (Brooklyn Heights, OH)
- …with the care team in the provision of patient care. Performs a clinical review of selected patients to determine service needs. Coordinates the care of selected ... patients. Integrates and coordinates access and utilization management, proactive patient panel management, care facilitation, and...Possess a current license to practice as a Registered Nurse in the State of Ohio. 3 years of… more
- MetroHealth (Brooklyn Heights, OH)
- …with the care team in the provision of patient care. Performs a clinical review of selected patients to determine service needs. Coordinates the care of selected ... patients. Integrates and coordinates access and utilization management, proactive patient panel management, care facilitation, and treatment planning functions.… more
- Molina Healthcare (Cleveland, OH)
- …and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new ... unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality… more