- MetroHealth (Cleveland, OH)
- …patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is ... in Nursing (applies to placements after 1/1/2017). Current Registered Nurse License State of Ohio. Minimum of five years...skills. Preferred: Two years of experience with case management, utilization review . Physical Demands: May need to… 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
- Elevance Health (Seven Hills, OH)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... 8am - 5pm CST or 8am - 5pm EST** The Med Mgmt Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical… more
- Fresenius Medical Center (Elyria, OH)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Veterans Affairs, Veterans Health Administration (Cleveland, OH)
- …Schedules patient appointments Coordinates with the patient care team to review the clinic utilization by using various reports (eg, ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability utilization ) to ensure that clinic schedules… more
- Cleveland Clinic (Cleveland, OH)
- …A caregiver who excels in this role will: + Payer Denial Management Nurse : + Support the denial and appeal process within the Payer Denial Management ... documentation, criteria application and physician advisor input. + Complete review of the medical record and formulate the appeal...to assist with appeal defense process. + RAC/Payer Audit Nurse : + Support denials and appeals within the Payer… more
- Veterans Affairs, Veterans Health Administration (Cleveland, OH)
- …not limited to: Schedules patient appointments. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic ... of medical clinicians across multiple disciplines eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical… 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
- Fresenius Medical Center (Cleveland, OH)
- …barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing Orders, clinical ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …health promotion projects. Directs the clinical abstraction process to coordinate chart review for HEDIS and report back findings to network providers. . Provides ... Master's degree preferred. . 8 years progressive health care experience in case, utilization , or quality management; 3 years of which are in management or high-level… more