- Elevance Health (Independence, OH)
- …health, behavioral health, long term services and supports, and psychosocial needs._ ** Medical Management Clinician ** **Location:** This role enables ... hours may be necessary based on company needs. The ** Medical Management Clinician ** responsible for ensuring appropriate, consistent administration… more
- Elevance Health (Waverly, OH)
- **LTSS Service Coordinator - Clinician (Case Manager)** **Hiring near Chillicothe, Findlay, Gallipolis, Ironton, Jackson, Lima, Marietta, Portsmouth, Wapakoneta, ... term services and supports, and psychosocial needs. The **LTSS Service Coordinator- Clinician ** is responsible for working under the direction/supervision of an RN,… more
- Elevance Health (Marietta, OH)
- …an accommodation is granted as required by law._ The **LTSS Service Coordinator-RN Clinician ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN Clinician (Case Manager)** **Hiring in the following counties: Athens, Hocking, Meigs, Morgan, Noble, Perry, and Washington.**… more
- Molina Healthcare (Cleveland, OH)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This position… more
- Highmark Health (Columbus, OH)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of ... or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment and retrospective… more
- Datavant (Columbus, OH)
- …computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus. Minimum Education: LVN/LPN + ... utilization of available health services, review of admissions for medical necessity and necessity of continued stay in the...as it relates to job function as delegated by management Ideal candidate should be a Licensed Practical Nurse… more
- Molina Healthcare (Dayton, OH)
- …in Healthcare Management (CPHM). * Recent hospital experience in a medical unit or emergency room. Previous experience in managed care Prior Auth, Utilization ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner.… more
- Molina Healthcare (Dayton, OH)
- …Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.… more
- Molina Healthcare (Akron, OH)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Nurse (RN). **Required Experience** 1-3 years of hospital or medical clinic experience. **Required License, Certification, Association** Active, unrestricted State… more
- Molina Healthcare (Cleveland, OH)
- …* Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2 years… more
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