- Molina Healthcare (Dayton, OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... least 2 years experience, including experience in hospital acute care , inpatient review , prior authorization, managed ...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Akron, OH)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization...experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (Columbus, OH)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Cleveland Clinic (Cleveland, OH)
- …include: + Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Completed Registered Nurse First ... experience Preferred qualifications for the ideal future caregiver include: + Certified Registered Nurse First Assistant (CRNFA) Certification + BSN Our… more
- Highmark Health (Columbus, OH)
- …of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes… more
- Datavant (Columbus, OH)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to… more
- Cleveland Clinic (Cleveland, OH)
- Nationally certified Advanced Practice Provider who provides primary and/or specialty care in a variety of healthcare settings. Functions in collaboration with the ... health care team in accordance with certification and licensure. Practice... certified) or PA** to work as an independent clinician in collaboration with physicians, fellows, residents, and other… more
- Kestra Medical Technologies, Inc (Columbus, OH)
- …+ Knowledge of MS Office, Excel, PowerPoint, MS Teams + Direct cardiac patient care experience - RN , RT, CVIS, Paramedic, CRM WORK ENVIRONMENT + Variable ... comfort and dignity. Innovating versatile new ways to deliver care , Kestra is helping patients and their care...the patient to determine the correct garment size + Review and transmit essential paperwork with the patient to… more
- Elevance Health (Independence, OH)
- …in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex or ... **Medical Management Nurse ** **Location: Virtual: This role enables associates to...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any… more