- UnitedHealthcare (Columbus, OH)
- …may be interested in. Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse in Ohio 2+ years of clinical experience as an RN ... job, please make sure you meet the following requirements as listed below. The RN Clinical Care Coordinator will be the primary care manager for a panel of members… more
- Battelle Memorial Institute (Columbus, OH)
- …Health Technician will require performing a variety of administrative and clinical tasks, including data collection, report preparation, and coordination of ... operations and high-quality patient care. **Responsibilities** + Assist with the management and treatment of outpatient behavioral health activities + Under the… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Columbus, OH)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CVS Health (Columbus, OH)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… 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 ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Molina Healthcare (Columbus, OH)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Trinity Health (Powell, OH)
- …demeanor in difficult situations. . Knowledge of the functional operations of utilization management , discharge planning, business offices, and third party ... **Employment Type:** Full time **Shift:** **Description:** **Family Nurse Practitioner, Full-Time** **Position Purpose:** The APRN - Nurse Practitioner provides… more
- Elevance Health (Columbus, OH)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Elevance Health (Columbus, OH)
- …**Preferred Skills, Capabilities and Experiences** : + AS or BS in Nursing. + Utilization Management , medical management , or appeals experience. + Leadership ... ** Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason,...appeals/grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Trinity Health (Columbus, OH)
- …Minimum of 5 years acute care medical or surgical experience required;** ** Utilization /Case Management , managed care, or Clinical Documentation and ... management , coding specialists and other healthcare disciplines regarding clinical documentation issues. + Utilizes computer systems effectively and maintains… more
- Molina Healthcare (Columbus, OH)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Columbus, OH)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,...Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating strong management … more
- ChenMed (Columbus, OH)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to ... our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare… more
- Molina Healthcare (Columbus, OH)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- ChenMed (Columbus, OH)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other programs that maximize and ... ( _with the support of the Care Team and Nurse Practitioner/Physician Assistant depending on ratio_ ). + Assesses...practices and procedures within the Cardiology field + Superior clinical skills in the management of seniors… more
- Trinity Health (Westerville, OH)
- …transfer or discharge. This is done with the intentions of cost-effective utilization of hospital resources, minimizing out of pocket expenses for patients, ... providing customer support to our internal and external customers, appropriate utilization of resources and patient advocacy. **What you will do:** + Identifies… more
