- Cognizant (Columbus, OH)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Based on this role's business requirements, this is a remote position open to qualified applicants in United States.… more
- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... 8:00am-5:00pm EST (Shift times vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division… more
- Highmark Health (Columbus, OH)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Humana (Columbus, OH)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Evolent (Columbus, OH)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Molina Healthcare (Cleveland, OH)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical/medical reviews...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Humana (Columbus, OH)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Optiv (Columbus, OH)
- …right staff assignments are made in right timeframes. + Maximize utilization . + Increase visibility of availability. + Assess skills/certifications against pipeline, ... the identification and assignment of services team members and subcontractors. + Review schedule data proactively to maintain high degree of timelines, accuracy, and… more
- Capital One (Columbus, OH)
- Sr. Manager, Technical Writer - Capital One Software ( Remote ) Ever since our first credit card customer in 1994, Capital One has recognized that technology and data ... complex information into user-friendly content that enables successful onboarding and utilization of Databolt by customers, partners and internal stakeholders. This… more
- SitusAMC (Columbus, OH)
- …and address potential resource constraints or bottlenecks. + Report on resource utilization and manage capacity for the team. + **Project Planning and Coordination** ... (PPM) tool is a plus. + Experience working remotely and household setup conducive to remote work \#LI- AS1 #LI- Remote Note: This job description is not intended… more