• Registered Nurse (RN) - Admissions…

    Bon Secours Mercy Health (Lorain, OH)
    …referrals to establish eligibility for care; understand and communicates Center for Medicare & Medicaid Services ( CMS ) medical necessity and admission criteria. ... excellence. **Primary Function/General Purpose of Position** The Admissions Coordinator Registered Nurse (RN) is responsible for the coordination of all Acute… more
    Bon Secours Mercy Health (05/19/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Cincinnati, OH)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports… more
    Molina Healthcare (08/15/25)
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  • Utilization Management Nurse

    CenterWell (Columbus, OH)
    …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Columbus, OH)
    …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/02/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and ... lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment… more
    Medical Mutual of Ohio (08/16/25)
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  • Clinical Program Manager- Payment Integrity…

    Molina Healthcare (Cleveland, OH)
    …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides… more
    Molina Healthcare (08/14/25)
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  • Patient Care Technician - PCT

    Fresenius Medical Center (Youngstown, OH)
    …material assist devices for the heavier items. **EDUCATION** + Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification or High ... paid & structured training with an assigned Preceptor & Nurse Educator + 70,000 + dedicated employees, 200,000 +...testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . + Ensure that all… more
    Fresenius Medical Center (08/16/25)
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  • Patient Care Technician - PCT

    Fresenius Medical Center (Cortland, OH)
    …**LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification ... dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance… more
    Fresenius Medical Center (08/13/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Produces reporting and ... for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report… more
    Medical Mutual of Ohio (08/08/25)
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  • Patient Care Technician - PCT

    Fresenius Medical Center (Lancaster, OH)
    …**LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification ... dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance… more
    Fresenius Medical Center (08/15/25)
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