- Lincoln Financial (Columbus, OH)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll… more
- CVS Health (New Albany, OH)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. RN ... and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management...on key questions and conversation. **Required:** - A Registered Nurse that must hold an unrestricted license in their… more
- Elevance Health (Mason, OH)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- The Patient Nurse Case Manager (PNCM) is a dynamic, field-based role that serves as a crucial educator for patients. This position helps to execute against a ... with states and local laws. **Company benefits** : Comprehensive medical , dental, vision, prescription drug coverage, company provided basic...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Molina Healthcare (Cincinnati, OH)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific… more
- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, physician-developed … more
- Elevance Health (Mason, OH)
- **Transplant Nurse II** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Wednesday - Sunday or Thursday - Monday. The **Transplant Nurse II** will be responsible for providing case and/or... II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to… more
- CVS Health (Columbus, OH)
- …change lives in new markets across the country. The Case Manager, Licensed Practical Nurse is responsible for care coordination of our members who are experiencing a ... members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status.… more
- Elevance Health (Mason, OH)
- ** Nurse Case Manager I - $3000 Sign-On Bonus** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... Schedule:** Monday - Friday 8:30a - 5p CST The ** Nurse Case Manager I** will be responsible for performing...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more