- CVS Health (Columbus, OH)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- CVS Health (Columbus, OH)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CVS Health (Columbus, OH)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Education**… more
- CVS Health (Columbus, OH)
- …3+ years of Med Surg experience as an RN in the hospital setting - Utilization Management experience - Active and unrestricted RN licensure in state of residence ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH **Schedule** - Mon-Fri 10:30AM-7PM… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- Molina Healthcare (Columbus, OH)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...and experience. * At least 5 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Molina Healthcare (Columbus, OH)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more