- Elevance Health (Mason, OH)
- …on the team in preparation for advancement to the senior level. Within the case management role will within the scope of licensure assess, develop, implement ... The **Transplant Nurse II** will be responsible for providing case and/or medical management for members receiving...claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within… more
- Bon Secours Mercy Health (Lima, OH)
- …to department policies. Identify, enroll and manage patients in program for Complex Case Management . Develop and implement care plans to maximize wellbeing with ... Degree or Licensure as required by state of practice Licensure/Certification Preferred: Case Management certification, LSW or LCSW **Minimum Qualifications** 2-3… more
- Sharecare (Columbus, OH)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Advocates (Nurse) for conditions that require clinical care and case management assistance + Primary duties include… more
- Prime Therapeutics (Columbus, OH)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...appeals program. + Participates in meetings and consults with management on regular basis to discuss member interaction and… more
- ProMedica Health System (Toledo, OH)
- …other health care providers, family members, schools, court staff, attorneys, and case managers. Participates in utilization management activities as ... methods. Maintains related records and collaborates with other caregivers, case managers and managed care representatives. ACCOUNTABILITIES *All duties listed… more
- Somatus (Cleveland, OH)
- …more! Collaborate with local leadership and/or provider engagement to build relationships with case management teams at strategic facilities in assigned area as ... identified by the Operations Manager , provide information and education on Somatus program benefits...discharge. The Hospital Liaison will work with the RNCM, case management and care givers to identify… more
- Elevance Health (OH)
- …patients with IDD and patients with special needs is preferred. + Home Health, Utilization Management or Case Management experience strongly preferred. ... community agencies and appropriate provider/network. + Refers member to catastrophic case management . **Minimum Requirements:** Requires AS in nursing and… more
- Elevance Health (Mason, OH)
- **Clinical Operations Associate Medical Director** **Carelon Medical Benefits Management ** **Radiology Benefit** ** Management / Utilization ** **Review** ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
- ChenMed (Columbus, OH)
- …development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed ... and in collaboration with other health care professionals. Consults with the manager , physician, and medical director to ensure compliance with guidelines. This… more
- Bon Secours Mercy Health (Toledo, OH)
- …that promote health, prevent disease and seek early treatment. + Provides nursing case management for assigned patients. Follows guidelines for care according to ... collaboration with healthcare team members. + Demonstrates knowledge and appropriate utilization of community resources and agencies to promote ongoing support for… more
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