- UnitedHealthcare (Columbus, OH)
- …on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a ... and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants… more
- CVS Health (Columbus, OH)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CVS Health (Columbus, OH)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Molina Healthcare (Columbus, OH)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… 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
- Evolent (Columbus, OH)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Fresenius Medical Center (Columbus, OH)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Trinity Health (Columbus, OH)
- …faxes and authorizations in HealthQuest + Communicate information received from payers to utilization review nurse . + Transmit continued stay reviews and track ... **Employment Type:** Full time **Shift:** **Description:** **Senior Coordinator for Case Management , Mount Carmel East** **Position Purpose:** The Senior Case … 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
- Sevita (Columbus, OH)
- …team (ie, state-wide initiatives); coaches ADs on ongoing training efforts. **Financial Management :** 1. Management : Responsible for the financial performance of ... etc.; implements strategies to manage overtime. 3. Individuals' Served Funds Management : Safeguards individuals' funds and ensures compliance within region. **Census… more
- ChenMed (Columbus, OH)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… 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 ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of… 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
- 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
- Trinity Health (Westerville, OH)
- …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. **Responsibilities** + Identifies discharge… more
- Trinity Health (Grove City, OH)
- …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. *This position will help cover weekends and… more
