• Utilization Review Nurse - Full Time

    Dayton Children's Hospital (Dayton, OH)
    Facility:Dayton Children's - Main CampusDepartment:Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization ... Management, the Utilization Review RN conducts medical record review for...and collaborates with the Denials team assisting to prevent concurrent and retrospective denials. The Physician Advisor role will… more
    Dayton Children's Hospital (10/04/25)
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  • Registered Nurse - Remote

    Cognizant (Columbus, OH)
    …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization… more
    Cognizant (10/07/25)
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  • Supervisor, Utilization Management

    Centene Corporation (Columbus, OH)
    …a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
    Centene Corporation (09/17/25)
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  • Medical Director (AZ)

    Molina Healthcare (Cleveland, OH)
    …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
    Molina Healthcare (09/26/25)
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  • Medical Management Clinician Associate-2

    Elevance Health (Cincinnati, OH)
    …standard procedures that do not require the training or skill of a registered nurse . **How you will make an impact:** + Confirms medical services are appropriate ... plans and/or contracts. + Conducts and may approve precertification, concurrent , retrospective, out-of-network, and/or appropriateness of treatment setting reviews… more
    Elevance Health (10/02/25)
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  • RN Case Manager

    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 ... post-graduation of an accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015. Minimum 5 years post… more
    Prime Healthcare (10/01/25)
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  • Case Manager

    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 ... post-graduation of an accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015. Minimum 5 years post… more
    Prime Healthcare (09/24/25)
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  • Medical Management Clinician

    Elevance Health (Independence, OH)
    …complex case types that do not require the training or skill of a registered nurse . **How you will make an impact.** Primary duties may include, but are not limited ... less experienced staff. + Conducts and may approve precertification, concurrent , retrospective, out-of-network, and/or appropriateness of treatment setting reviews… more
    Elevance Health (09/10/25)
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