- Molina Healthcare (Columbus, OH)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
- Molina Healthcare (Columbus, OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
- CVS Health (Columbus, OH)
- …of residence.** **Position Summary** RN and certified coder Responsible for the review and evaluation of clinical information and documentation related to SIU ... more
- Prime Therapeutics (Columbus, OH)
- …staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when ... more
- Highmark Health (Columbus, OH)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... more
- Molina Healthcare (Columbus, OH)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
- Molina Healthcare (Columbus, OH)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
- CVS Health (Delaware, OH)
- …paid holidays, and flexibility as you coordinate the care of your members. Nurse Case Manager is responsible for telephonically and/or face to face assessing, ... more
- CVS Health (Columbus, OH)
- …holidays, and flexibility as you coordinate the care of your members. + Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, ... more
- CVS Health (Columbus, OH)
- …holidays, and flexibility as you coordinate the care of your members. Nurse Case Manager is responsible for telephonically assessing, planning, implementing, and ... more
- Elevance Health (Columbus, OH)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... more
- CVS Health (Columbus, OH)
- …plans. Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... more
- CVS Health (Columbus, OH)
- …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... more