- MetroHealth (Cleveland, OH)
- …selected patients as assigned. Assists the Care Coordinator with access and utilization management , proactive patient panel management , care facilitation, ... of a school-sponsored externship. Graduate of a Licensed Practical Nursing program. Registered in good standing as a State... Assistant (STNA) with the Ohio Department of Health Nurse Aide Registry. Fluency in writing, speaking, and interpreting… more
- Molina Healthcare (Columbus, OH)
- …**Preferred Experience** 3-5 years clinical practice with managed care, hospital nursing , utilization and/or care management experience. **Preferred ... the health plan HCS Department staff. Consults with the Management of HCS to devise and implement corrective action...courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited… more
- Prime Therapeutics (Columbus, OH)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At… more
- Trinity Health (Columbus, OH)
- …demeanor in difficult situations. + Knowledge of the functional operations of utilization management , discharge planning, care coordination and transitions of ... and care coordination along the continuum through effective transitional care management utilizing a multidisciplinary team. Our approach empowers the patient and… more
- Molina Healthcare (Columbus, OH)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing . **Required Experience** 3+ years hospital acute care/medical experience.… more
- Trinity Health (Westerville, OH)
- …Responsible for quality and standards of patient care, performance improvement, program management , business operations, budget and resource utilization , and ... areas, focusing on optimal patient outcomes, regulatory, compliance, risk management , and continuous quality and process improvement. **Minimum Qualifications:** +… more
- Trinity Health (New Albany, OH)
- …Responsible for quality and standards of patient care, performance improvement, program management , business operations, budget and resource utilization , and ... areas, focusing on optimal patient outcomes, regulatory, compliance, risk management , and continuous quality and process improvement. **Minimum Qualifications:** +… more
- Elevance Health (Mason, OH)
- …documents to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities which require the ... records to either approve or summarize and route to nursing and/or medical staff for review. + The grievance...a liaison between grievances & appeals and /or medical management , legal, and/or service operations and other internal departments.… more
- Bellefaire JCB (Summit, OH)
- …a member of an inter-disciplinary team to develop acute patient care plans, case management plans, and utilization reviews. + Initiate plan of treatment and ... Certified Nurse Practitioner-Summit, Medina, Lorain- Part Time SUMMARY: The...management . QUALIFICATIONS: Education: + A Master's degree in nursing with a concentration in mental health is preferred.… more
- Sedgwick (Columbus, OH)
- …Six (6) years of related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and quality… more