- Select Medical (Middleburg Heights, OH)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Molina Healthcare (Cincinnati, OH)
- …State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
- Trinity Health (Columbus, OH)
- …demeanor in difficult situations. . Knowledge of the functional operations of utilization management , discharge planning, care coordination and transitions of ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses...Education: RN Case Manager: Graduate from a school of nursing . . . Baccalaureate degree in nursing … more
- Elevance Health (Dayton, OH)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... fully integrated care plan. Engage the individual's support network and oversee management of their physical health, behavioral health, and long-term services and… more
- Bon Secours Mercy Health (Youngstown, OH)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... for Case Manager Certification or American Nurses Credentialing Center (ANCC) Nursing Case Management board certification (preferred) **Education** + Bachelor… more
- Highmark Health (Columbus, OH)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and… more
- Elevance Health (Mason, OH)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Molina Healthcare (OH)
- …only). **Preferred Experience** 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, ... Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE required.** **Individual state… more
- Humana (Columbus, OH)
- …during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- Elevance Health (Columbus, OH)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more