- CVS Health (Columbus, OH)
- …**Required Qualifications:** -3+ Years of clinical experience -1+ Year of Utilization Review Management and/or Medical Management ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases . Applies the appropriate clinical criteria/guideline to render a… more
- Molina Healthcare (Columbus, OH)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a ( RN ) Registered Nurse who lives in OHIO or KENTUCY and must be licensed for the state they reside Clinical Auditor RN ... **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization ... nurse and other clinical functions in Utilization Management (UM), Case Management … more
- Highmark Health (Columbus, OH)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- CVS Health (Columbus, OH)
- …reimbursement policy. + 1+ year of Coding experience **Preferred Qualifications** + Utilization Management review + Managed Care experience **Education** ... are 8am-5pm in time zone of residence.** **Position Summary** RN and certified coder Responsible for the review...experience required + 2+ years of experience as a Registered Nurse + Must have active, current… more
- CVS Health (Columbus, OH)
- …This is a full-time remote Utilization Management opportunity. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... zone + 3+ years of clinical experience as a Registered Nurse in a hospital setting including...of clinical experience in acute or post-acute setting + Utilization management is a 24/7 operation. Work… more
- Molina Healthcare (Columbus, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Trinity Health (Columbus, OH)
- …at least four (4) years of nursing experience, including two (2) years of utilization review /case management , managed care or comparable patient payment ... travel between locations within the Region. **Minimum Requirements:** + Registered Nurse and graduate of an accredited...managed care. + Knowledge of and experience in case management and utilization management . +… more
- Molina Healthcare (Columbus, OH)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Guardian Life (Columbus, OH)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- AmeriHealth Caritas (Dublin, OH)
- …complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Fresenius Medical Center (Columbus, OH)
- …meetings may be required. **SUPERVISION:** **None** **EDUCATION AND REQUIRED CREDENTIALS:** * Registered Nurse required *Certification in Nephrology Nursing or ... barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing Orders, clinical… more
- Elevance Health (Columbus, OH)
- …one must reside within 50 miles of an Elevance Health PulsePoint . The **Medical Management Nurse Lead** will be responsible for serving as the team lead, coach, ... and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians. Contributes...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more