• Registered Nurse ( RN ) Case…

    Trinity Health (Columbus, OH)
    …technology, financial analysis, audit, provider relations and more. **Position Purpose:** The RN Case Manager MCHP is responsible for the coordination of the medical ... 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 Plan.… more
    Trinity Health (01/07/26)
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  • RN Care Manager

    OhioHealth (Columbus, OH)
    …State of Ohio Board of Nursing, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job ... Description:** RN from an accredited school of Nursing with a...**Work Shift:** Day **Scheduled Weekly Hours :** 40 **Department** UM Care Coord-South Central Hu Join us! if your… more
    OhioHealth (10/24/25)
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  • Care Review Clinician ( RN )

    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 ... the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (12/24/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Cleveland, OH)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
    Molina Healthcare (01/09/26)
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  • RN Care Manager, Part-time 24hr wee, Grant…

    OhioHealth (Columbus, OH)
    …Resuscitation - American Red Cross, DL - Driver's License - Department of Motor Vehicles, RN - Registered Nurse - Ohio Board of Nursing **Additional Job ... Description:** **Work Shift:** Day **Scheduled Weekly Hours :** 24 **Department** UM Care Coord-South Central Hu Join us! if your passion is to work in a caring… more
    OhioHealth (12/24/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Akron, OH)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
    Molina Healthcare (10/25/25)
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  • Concurrent Denial Nurse BU - Utilization…

    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...peer-to-peer process. + Perform the routine activities of a UM Specialist when needed while taking a leadership role.… more
    Cleveland Clinic (01/13/26)
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  • Senior Strategy Advancement Professional

    Humana (Columbus, OH)
    …and advancement of strategic initiatives within the Utilization Management ( UM ) function. This role is responsible for leveraging data-driven insights, ... industry best practices, and cross-functional collaboration to optimize UM processes, improve clinical outcomes, and enhance member and provider experiences. The… more
    Humana (01/07/26)
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  • Clinical Reviewer, Nurse (Medical Oncology)

    Evolent (Columbus, OH)
    …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed… more
    Evolent (12/10/25)
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  • Utilization Management Clinical Team Lead (Remote)

    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 ... times are not permitted. **Required Qualifications** + Active, unrestricted RN license in your state of residence with multistate/compact...a managed care setting). + Ability to provide on-call UM coverage for nights and weekends on a rotational… more
    CVS Health (12/19/25)
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