- Molina Healthcare (Akron, 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
- Molina Healthcare (Akron, OH)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more
- Molina Healthcare (Cleveland, OH)
- …skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and ... including design, development, implementation, and oversight of technology that drives core utilization management , care management , long-term services and… more
- Select Medical (Dublin, OH)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... Social Work or in a clinical or related discipline ( RN preferred), per state guidelines for case management...( RN preferred), per state guidelines for case management and/or discharge planning, required. + Ability to provide… more
- Molina Healthcare (Akron, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- UC Health (Cincinnati, OH)
- …policies/procedures to perform reviews on denied accounts. Utilizing knowledge of utilization management regulations, registration, claims, and payor policies ... UC Health is hiring a Full Time RN (Denials/Charge Audits) for Patient Financial Services Under...the Denial Management nurse will work assigned accounts to… 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 )...volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's… more
- Cleveland Clinic (Cleveland, OH)
- …stellar care at one of the top healthcare organizations in the nation. As a Registered Nurse ( RN ) Case Manager, you will work collaboratively with ... of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic...of hire + Two years of recent experience in utilization review, quality or care management +… more
- Select Medical (Dublin, OH)
- …within the allotted time frame; assuring payments of services meeting patient-related utilization management criteria, and implementation of safe and appropriate ... + Current Licensure in a clinical discipline per state guidelines required. ( Registered Nurse or Social Work (SW) preferred) **Preferred Qualifications** +… more