• Utilization Management Representative I

    Elevance Health (Mason, OH)
    …and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data entry of referral requests ... into the UM system in accordance with the plan certificate. +...an equivalent background. **Preferred Skills, Capabilities and Experiences** + Medical terminology training and experience in medical more
    Elevance Health (08/29/25)
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  • Care Review Clinician, PA (RN) Transplants

    Molina Healthcare (Cincinnati, OH)
    …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
    Molina Healthcare (08/31/25)
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