- Premier Health (Dayton, OH)
- …years of job related experience Prior job title or occupational experience: Case management , utilization review, clinical nurse Prior specific functional ... with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management , utilization of information systems and regulatory… more
- MetroHealth (Brooklyn Heights, OH)
- …Coordinates the care of selected patients. Integrates and coordinates access and utilization management , proactive patient panel management , care ... The MetroHealth System.** Qualifications: Required: Bachelor of Science in Nursing . Valid Ohio RN licensure. Three to Five years...Ohio RN licensure. Three to Five years of case management or managed care experience. Ability to work independently… more
- Elevance Health (Mason, OH)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** **Virtual:** This role enables...RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Molina Healthcare (Cincinnati, OH)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Actalent (Cincinnati, OH)
- …ensure the successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization, utilization ... Job Title: Clinical Review Nurse 100% Remote Eastern and Central time zones...Proficiency with InterQual. + Active Compact RN/LVN/LPN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience.… more
- Evolent (Columbus, OH)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (OH)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Humana (Columbus, OH)
- … licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... review depending on case findings. + Educates providers on utilization and medical management processes. + Enters...health or rehab + Certification in Case Management (CCM) or Managed Care Nursing (CMCN)… more
- Dayton Children's Hospital (Dayton, OH)
- …and facilitate care coordination of timely/necessary medical care, discharge planning, utilization management , and community referrals. Develops and implements ... information to payors. As part of the team, makes decisions regarding utilization management and alternative treatment which reflects cost effectiveness.… more
- CenterWell (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more