- Cognizant (Columbus, OH)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- Humana (Columbus, OH)
- …include timely data entry in MSR. * Perform accurate and timely assessment and concurrent review of outlier admissions using InterQual criteria and document ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Centene Corporation (Columbus, OH)
- …on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review … more
- Molina Healthcare (Cleveland, OH)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- Elevance Health (Cincinnati, OH)
- …Requires HS diploma or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- Elevance Health (Independence, OH)
- …+ Requires HS diploma or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- Prime Healthcare (Coshocton, OH)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. +… more
- Prime Healthcare (East Liverpool, OH)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. +… more