- 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...multistate/compact licensure privileges. **Preferred Qualifications** + 1+ year(s) of Appeals experience in Utilization Management .… more
- Evolent (Columbus, OH)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Cognizant (Columbus, OH)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Molina Healthcare (Akron, OH)
- …decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Molina Healthcare (Cleveland, OH)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more