- Sedgwick (Columbus, OH)
- …to advance to the next round, a recruiter will be in touch. \# nurse #fieldcasemanager As required by law, Sedgwick provides a reasonable range of compensation ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Premier Health (Dayton, OH)
- …to come to the office **in-person.** Premier Health is looking for an experienced RN Nurse - Risk Manager to lead our Risk Management & System Projects team in ... Health in Dayton, Ohio, is seeking a dedicated RN Nurse - Risk Manager to join our esteemed team....exam. + Preferred: Background in professional nursing law or insurance/ claims + Strong leadership, analytical, and communication skills +… more
- Public Consulting Group (Columbus, OH)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... Proven working experience in case management, including as a nurse , medical, mental health care manager or a related...+ Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions** + Office Setting… more
- Morley (Columbus, OH)
- …to Make Your Life Easier_** + Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help with benefit questions and claims ... issues + Family, financial and estate guidance (will) services **_About Morley_** Our mission is to deliver extraordinary experiences. We do this by leading with humility, embracing everyone, sweating the details and moving mountains (making the impossible… more
- CVS Health (New Albany, OH)
- …(1-2 times per quarter).** Typical training hours are Monday-Friday 8-4:30 EST. Nurse Care Manager is responsible for telephonically and/or face to face assessing, ... including co-morbid and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management and eligibility.… more
- CVS Health (Columbus, OH)
- …Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate ... regarding confidentiality. + May assist in the research and resolution of claims payment issues. Supports the administration of the hospital care, case management… more
- Molina Healthcare (Cincinnati, OH)
- …focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial… more
- Medical Mutual of Ohio (OH)
- …and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of ... . Ability to utilize certified HEDIS software. . Ability to analyze clinical, claims , pharmacy, encounter, and quality measurement data. . Advanced knowledge of NCQA… more
- Morley (Columbus, OH)
- …to Make Your Life Easier_** + Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help with benefit questions and claims ... issues + Family, financial and estate guidance (will) services **_About Morley_** Our mission is to deliver extraordinary experiences. We do this by leading with humility, embracing everyone, sweating the details and moving mountains (making the impossible… more
- CommonSpirit Health (Steubenville, OH)
- …Full Time, Monday - Friday, 8:00am - 4:30pm + 3 Physicians and 2 Nurse Practitioners in Practice + Reasonable Census: Provide focused care with manageable patient ... Dues, and Certification Reimbursement + Malpractice and Tail Insurance (Modified Claims Made) + Full Benefits Eligibility with CommonSpirit Health: Enjoy… more