- Trinity Health (Columbus, OH)
- …as appropriate. Assists in the implementation of Case Management software along with the Plan's UM and QM Program and the review of the Plan's Medical Management ... United States. We're dedicated to providing excellent customer service, cost-effective care , and exceptional healthcare coverage. We rely on talented colleagues in… more
- Molina Healthcare (OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Cleveland, OH)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Akron, OH)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Cleveland Clinic (Cleveland, OH)
- …Program ( RN ) + Current valid license in the State of Florida as a Registered Nurse ( RN ) + Basic Life Support (BLS) certification through the American ... necessity criteria is met. We are looking for a Registered Nurse who is a subject matter...basic disease processes. + Utilize knowledge and experience with Care Guidelines and /or other UM criteria… more
- Evolent (Columbus, OH)
- …medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum ... for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification...of experience with medical management activities in a managed care environment + UM /UR experience + Clinical… more
- Elevance Health (Columbus, OH)
- Behavioral Health Care Manager I- Behavioral Health Care Manager I **Locations:** The selected candidate must reside within a reasonable commuting distance of ... is granted as required by law. The **Behavioral Health Care Manager I** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Highmark Health (Columbus, OH)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...**LICENSES or CERTIFICATIONS** **Required** + Current State of PA RN licensure OR Current multi-state licensure through the enhanced… more
- CVS Health (Columbus, OH)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team **Position Summary** The Team ... applications. + 2+ years of healthcare management experience required (preferably in a managed care setting). + Ability to provide on-call UM coverage for nights… more