- CVS Health (Columbus, OH)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. **Key Responsibilities** ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Molina Healthcare (OH)
- …this position we are hiring for a float team to support PEGA UM systems throughout multiple states.** **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Akron, OH)
- …Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and ... procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and… more
- Molina Healthcare (Cleveland, OH)
- …or a compact licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Humana (Columbus, OH)
- …+ Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and facilitating NCQA UM ... Health; MED-Deeming accreditation standards knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care, Medicaid health… more
- Centene Corporation (Columbus, OH)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency… more
- Molina Healthcare (Columbus, OH)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... teams to promote Molina Care Model + Adheres to UM policies and procedures. **JOB QUALIFICATIONS** **Required Education** Any...of the following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)… more
- Molina Healthcare (Columbus, OH)
- …Utilization Review Lead responsibilities also include but not limited to, collaborate with UM Leadership to ensure the Daily Auth Reconciliation Report (DARR) is run ... **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical… more
- CVS Health (Columbus, OH)
- …all with heart, each and every day. **Position Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior ... evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. + Utilizes clinical experience and… more
- Sharecare (Columbus, OH)
- …new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical , dental, and ... present premier provider options, including but not limited to medical , dental, and vision plans + Support for spending...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more