- CVS Health (Columbus, OH)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... determination of the appropriate courses of action. The SNF Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CenterWell (Columbus, OH)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- CenterWell (Columbus, OH)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
- CVS Health (Columbus, OH)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Columbus, OH)
- …Qualifications** + Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse ( RN ) with unrestricted Ohio state license with ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN… more
- CVS Health (Columbus, OH)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Cleveland, OH)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Bon Secours Mercy Health (Lorain, OH)
- …and operational excellence. **Primary Function/General Purpose of Position** The Admissions Coordinator Registered Nurse ( RN ) is responsible for the ... to acute rehab unit. Maintains expertise in clinical field, utilization review and case management ; communicates to...of Science Nursing (required) **Work Experience** 3 years of Registered Nurse ( RN ) clinical experience… more