- Elevance Health (Mason, OH)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Molina Healthcare (Cincinnati, OH)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… 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
- Molina Healthcare (Cleveland, 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
- Highmark Health (Columbus, OH)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- Cleveland Clinic (Cleveland, OH)
- …+ Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through the ... respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities,...Three years of equivalent full-time clinical experience as a Registered Nurse + Analytical ability required to… more
- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- CVS Health (Columbus, OH)
- …Qualifications** + Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse ( RN ) with unrestricted Ohio state license with ... each and every day. **Position Summary** The Behavioral Health UM Clinician position is designed to clinically review of...Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN… more
- Evolent (Columbus, OH)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… 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 ... Summary** The Appeals Nurse Consultant plays a key role in resolving clinical...medical records and applying clinical guidelines for Utilization Management group. This RN must be licensed… more
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