- Molina Healthcare (Cincinnati, OH)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** ... of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated...+ 3 years experience as a Registered Nurse in acute care, critical care, emergency medical… more
- CVS Health (Delaware, OH)
- …Franklin, Delaware, Madison, Pickaway or Union Counties, Ohio + Must have active and unrestricted Registered Nurse ( RN ) Licensure in the state of Ohio + 2+ ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...in Nursing **License** + Must have active and unrestricted Registered Nurse ( RN ) Licensure in… more
- CVS Health (Oregon, OH)
- …needs based on key questions and conversation. **Required Qualifications** - Active and unrestricted Registered Nurse ( RN ) or Licensed in Social Work (LISW) ... We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. This opportunity offers… more
- CVS Health (Oregon, OH)
- …and health needs based on key questions and conversation. **Required Qualifications** - Active Registered Nurse ( RN ) License - 3 years of clinical experience ... day. **Position Summary** _- Must reside in_ **_Ohio_** The Nurse Case Manager is responsible for telephonically and/or face...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Public Consulting Group (Columbus, OH)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (OH)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Columbus, OH)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- Trinity Health (Columbus, OH)
- …(JD) degree preferred. + **Licensure / Certification:** State of Ohio Licensed Registered Nurse required; Certified Professional in Healthcare Risk Management ... of You! **What we offer:** + Competitive compensation and benefits packages ( medical , dental, and vision) + Retirement savings account with employer match starting… more
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