- ChenMed (Cincinnati, OH)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse 1, Care Line, is responsible for providing telephonic triage directional ... and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the… more
- Molina Healthcare (Columbus, OH)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… 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... license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Molina Healthcare (Cincinnati, OH)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
- Elevance Health (OH)
- …patients with IDD and patients with special needs is preferred. + Home Health, Utilization Management or Case Management experience strongly preferred. + ... **Transitions of Care - RN , 100% Virtual, CareBridge** Location: This role enables...for participating in delivery of patient education and disease management interventions and for performing health coaching for members,… more
- Actalent (Cincinnati, OH)
- …, and discharge planning. + Proficiency with InterQual. + Active Compact RN /LVN/LPN License. + Utilization Management /Concurrent Review experience. + ... Job Title: Clinical Review Nurse 100% Remote Eastern and Central time zones...successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization, … more
- Intermountain Health (Columbus, OH)
- …/Professional Nursing program. + Required Licensure/Certification: State licensure as a Registered Nurse ( RN ). Preferred Qualifications + Bachelor's ... cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care.… more
- Molina Healthcare (Columbus, OH)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Cleveland Clinic (Cleveland, OH)
- …Precautions using personal protective equipment as required for procedures Keywords: : RN , Registered Nurse , Case Management , Case Manager, RN Case ... approved entity + Two years of recent experience in utilization review, quality or care management +...Care RN , Critical Care Registered Nurse , ED RN , Care Management ,… 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 ... skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license ( RN )...mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's… more