- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the ... Plan's UM Program and the review of the Plan's Utilization Management Plan. **What you will do**...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… more
- 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)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CenterWell (Columbus, OH)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- Molina Healthcare (OH)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong… more
- Molina Healthcare (Akron, OH)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Bon Secours Mercy Health (Youngstown, OH)
- …of Primary Function/General Purpose of Position** In the capacity of a Care Transition Nurse / Registered Nurse ( RN ), provide and facilitate coordination ... in Nursing (required) Bachelor's Degree in Nursing (BSN) (preferred) **Licensing/ Certifications:** Registered Nurse with active License in State of Patient Care… more
- 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 ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- CVS Health (Columbus, OH)
- …chronic conditions. + **Diabetes education experience** is required. + Current, unrestricted ** Registered Nurse ( RN ) license** ; multi-state licensure ... and ensures access to psychosocial support services. The goal is to optimize resource utilization and drive positive health outcomes. The RN will use strong… more