- CVS Health (Columbus, OH)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Appeals Nurse ... with possible weekends based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must be… more
- Cognizant (Columbus, OH)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Humana (Columbus, OH)
- …put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Highmark Health (Columbus, OH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Lincoln Financial (Columbus, OH)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee residing outside...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Bon Secours Mercy Health (Springfield, OH)
- …excellence. **Summary of Primary Function** In the capacity of a Registered Nurse (RN), the Ambulatory Care Manager will provide clinical care management ... of care to ensure medically appropriate cost-effective care. This is primarily a remote /work at home position, but hire should live driving distance from Columbus,… more
- Molina Healthcare (Akron, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more