• Medical Claim Review

    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 (01/25/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    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
    Molina Healthcare (02/09/25)
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  • Special Investigation Unit Nurse Consultant…

    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
    CVS Health (02/03/25)
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  • Initial Review Pharmacy Technician

    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
    Prime Therapeutics (02/12/25)
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  • Medical Director (Medicare)

    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 (02/09/25)
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  • Medical Director Specialty Medical

    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 (02/07/25)
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  • Case Manager RN - Field (Franklin, Delaware,…

    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 (02/12/25)
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  • Case Manager RN - Field (Franklin, Delaware,…

    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 (02/12/25)
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  • Case Manager RN (Remote, OH)

    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
    CVS Health (02/13/25)
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  • Utilization Management Representative II

    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
    Elevance Health (01/25/25)
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  • Care Management Associate - OhioRISE

    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 (02/06/25)
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  • Special Investigation Unit Manager Clinical…

    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
    CVS Health (12/25/24)
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