- Universal Health Services, Inc. (Willoughby, OH)
- Responsibilities Windsor Laurelwood Center for Behavioral Medicine We are looking for a Utilization Review Coordinator to join our team! In this role as UR ... in patient assessment, family motivation, treatment planning and communication with external review organization or comparable entities. Licensure: RN or LPN… more
- CareSource (Dayton, OH)
- …solving skills Leadership skills and experience Licensure and Certification: Current, unrestricted Registered Nurse ( RN ) license in state of practice ... with development of Case Management/Outreach processes that facilitate cost-effective service utilization and appropriate levels of care Regular travel to conduct… more
- UnitedHealth Group (Circleville, OH)
- …care, linking to necessary services and providing education about their health Review available member service records and relevant documentation (eg utilization ... Identify member support systems available and incorporate into their Care Plan Review plan benefits and identify appropriate programs and services based on health… more
- Parexel (Columbus, OH)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- Humana (Columbus, OH)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (OH)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... **Job Description** **Job Summary** The Medical Review Nurse provides support for medical...our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The… more
- Molina Healthcare (Akron, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- ChenMed (Cleveland, OH)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The incumbent in this role ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- CenterWell (Marion, OH)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Fresenius Medical Center (Youngstown, 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 (Cincinnati, OH)
- … Nurse - Community Living Center (CLC): The Community Living Center (CLC) Registered Nurse ( RN ) is responsible for delivering fundamental knowledge-based ... Summary This is an open continuous announcement to fill Registered Nurse positions at the Community Living...For more information, refer to Required Documents below. *CLC RN positions are currently EDRP eligible. Responsibilities The VA… more
- Cleveland Clinic (Warrensville Heights, OH)
- …from an accredited school of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through ... of the most respected healthcare organizations in the world. RN Case Managers work collaboratively with inter-professional teams across...or AHA) + Two years of recent experience in utilization review , quality or care management +… more
- Cleveland Clinic (Cleveland, OH)
- …from an accredited school of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through ... most respected healthcare organizations in the world. As an RN Case Manager, you will float between all bedside...approved entity + Two years of recent experience in utilization review , quality or care management +… more
- Elevance Health (Mason, OH)
- …relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. Primary duties may ... a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid...review experience. + Current active, valid and unrestricted RN license and/or certification to practice as a health… more
- MTC (Marion, OH)
- …use of appropriate sanitation methods. 13. Practice basic cost containment and utilization management for patient care and facility operations. 14. Maintain absolute ... and confidentiality of all medical records; observe applicable HIPAA rules. 15. Review medical files to determine all provided services are documented. 16. Closely… more
- Elevance Health (Independence, OH)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the...is preferred. + Medical Management experience is preferred, + Utilization Review experience is preferred. + Knowledge… more
- Trinity Health (Columbus, OH)
- …faxes and authorizations in HealthQuest + Communicate information received from payers to utilization review nurse . + Transmit continued stay reviews and ... Management extender would work under the direction of the RN Care Managers, Utilization Review ...Bachelor's degree preferred. + Medical assistant or Licensed Practical Nurse (LPN) highly preferred. + 5-7 years of customer… more
- Humana (Columbus, OH)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments… more
- Deloitte (Cincinnati, OH)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more
- Molina Healthcare (Dayton, OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
