- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the Utilization Management Department by ... criteria is met. We are looking for a Registered Nurse who is a subject matter expert in utilization...to the department in general and the hospital. + Review and analyze concurrent and retrospective clinical… 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 ... 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
- Trinity Health (Columbus, OH)
- …and other operational departments regarding case management issues. + Conducts inpatient concurrent review . + Documents and communicates to QM staff ... with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan. **What we...experience with at least 2 years experience in utilization review , discharge planning, case management, or disease management experience… more
- Actalent (Columbus, OH)
- "Immediate Hiring for "Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... of care. Qualifications: + 4+ years experience in utilization management and utilization review /managed care/hospital setting as an RN is Mandatory + ER & ICU… 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 ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/240947/registered- nurse -case-manager/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityEast Liverpool… 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 ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236790/registered- nurse -case-manager/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityEast Liverpool… more
- ChenMed (Columbus, OH)
- …+ Participates in surveys, studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and criteria as ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization; provides family… 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 ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
- Elevance Health (Mason, OH)
- …complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. **How You Will Make an Impact** ... guidelines within scope of licensure. + These reviews may require in-depth review ; however, any deviation from application of benefits plans will require guidance… more
- Elevance Health (Columbus, 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