- CVS Health (Columbus, OH)
- …Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, ... client needs. + Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and… more
- Molina Healthcare (Cincinnati, OH)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- Sedgwick (Columbus, OH)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and quality ... work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Responsible for auditing, tracking/trending audit results, and development and delivery of training to correct… more