- Elevance Health (Cincinnati, OH)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Schedule: Monday-Friday 8am-5pm Eastern...limited to: Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides… more
- Molina Healthcare (Cincinnati, OH)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Cleveland, OH)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Molina Healthcare (Cincinnati, OH)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- CVS Health (Columbus, OH)
- …and supporting the implementation of Wellness Plans to promote effective utilization of healthcare services. This position promotes/supports quality effectiveness of ... to accommodate business needs. Position Responsibilities: + Responsible for initial review and triage of members. + Manages population health member enrollment… more