- Elevance Health (Columbus, OH)
- …Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including ... the hours from 9:00 am-6:00 pm, rotating weekend shifts. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness… more
- Evolent (Columbus, OH)
- …Participates in the development and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology ... primary care , we seek to ensure that care plans align with clinical evidence, respect... operation initiatives within a progressive and forward-thinking health care organization. + Experience in health plan … more
- Guardian Life (Columbus, OH)
- …issues, work capacity and RTW opportunities. Conduct analysis of claimant's current treatment plan and collaborate with health care providers and claimants to ... **Position Summary** The RN Clinical Consultant serves as a clinical ...with treating providers to assist individuals to obtain appropriate care and ensure optimal treatment outcomes and acts with… more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... Bachelor's Degree in Nursing **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Columbus, OH)
- …issues between members, providers and other members of the member's interdisciplinary care team, including referrals to state plan health care ... Association** Active and unrestricted State Pharmacy License for workplace and plan location. **Preferred Education** Ambulatory Care Residency **Preferred… more
- Fresenius Medical Center (Columbus, OH)
- …of their clinical and operational processes to impact patient centered care resulting in improved patient outcomes and satisfaction and decreased morbidity and ... Advisory Board Recommended Algorithms and Standing Orders, clinical pathways and clinical policies and procedures to improve care coordination and care… more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... continuum, including behavioral health and long-term care , for members with high need potential. HCS staff...all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence… more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... continuum, including behavioral health and long term care , for members with high need potential. HCS staff...all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence… more
- Fujifilm (Columbus, OH)
- …via phone at ###, or via e-mail at ###@fujifilm.com . Additionally, the affirmative program/ plan is available for review upon formal request by employees and ... **Overview** ** Clinical Specialist (ARDMS Certification Required) - Milwaukee, WI**...at FUJIFILM Sonosite. As the creator of point of care ultrasound, we dedicate every day to the innovation… more
- Fresenius Medical Center (Gahanna, OH)
- …Assessments + Assist the registered dietitian in development and implementation of nutrition plan of care + Review monthly nutrition data with ... may under direct guidance of the Renal Dietitian: + Review of Renal Nutrition Basics and other applicable components...Provide input to the development and implementation of nutrition plan of care + Create nutrition related… more
- CenterWell (Columbus, OH)
- …of our caring community and help us put health first** The Rx Clinical Programs Pharmacy Technician Representative 2 supports Pharmacists and patients by executing ... helps drive the strategy on comprehensive medication reviews. The Rx Clinical Programs Pharmacy Technician Representative 2 performs varied activities and moderately… more
- Prime Therapeutics (Columbus, OH)
- …drives every decision we make. **Job Posting Title** Dir, Specialty Clinical Solutions/Medical pharmacy exp required- REMOTE **Job Description** + Supports overall ... identification opportunities for improved management of Medical benefit drugs through clinical research and analytics that improve medical cost savings and provide… more
- CenterWell (Columbus, OH)
- …patients to offer medication therapy management programs and schedules medication review sessions with consultative pharmacists. Decisions are typically focus on ... benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan , time off (including paid time off, company and personal holidays,… more
- CVS Health (Columbus, OH)
- …in a collaborative process to implement, coordinate, monitor and evaluate medical review cases . Applies the appropriate clinical criteria/guideline to render ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use… more
- CVS Health (Columbus, OH)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. The Special Investigations Unit is seeking… more
- Humana (Columbus, OH)
- …Facility experience** + Previous experience in utilization management required + Prior clinical experience preferably in an acute care , skilled or rehabilitation ... us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of… more
- Molina Healthcare (Columbus, OH)
- …and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information from providers as needed to properly ... computer savvy- able to work within several computer systems at once + Managed care experience + High level of communication skills, both written and verbal + Call… more
- Option Care Health (Columbus, OH)
- …patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining ... margin of assigned therapies. Creates a VA specific sales plan and regularly assesses progress on opportunities within assigned...alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able… more
- CVS Health (Columbus, OH)
- … case management or crisis intervention as appropriate. + Coordinates and implements assigned care plan activities and monitors care plan progress. ... systems. Evaluation of Members: + Through the use of care management tools and information/data review , conducts...and service needs that may impact member outcomes and care planning components with appropriate referral to clinical… more
- Option Care Health (Dublin, OH)
- …patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining ... a licensed professional who provides direct and indirect patient care services under a physician's plan of...Clinical competency is maintained by providing direct patient care 20-40% of the time. In a Medicare Certified… more