- CVS Health (Columbus, OH)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Columbus, OH)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... on the telephone, and type on the computer. **Preferred Qualifications** Utilization Management experience preferred **Education** Diploma RN acceptable;… more
- CVS Health (Columbus, OH)
- …**Must have active current and unrestricted RN licensure in state of residence** ** Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area** **Managed Care experience preferred, especially Utilization Management ** **Preference for those residing in EST zones**… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such as admission, ... a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a...basic disease processes + Three years of equivalent full-time clinical experience as a Registered Nurse +… more
- Trinity Health (Columbus, OH)
- …technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the coordination of ... Plan's UM Program and the review of the Plan's Utilization Management Plan. **What you will do**.../ Certification: Current license to practice as a Registered Nurse in their home state or hold a compact… more
- Centene Corporation (Columbus, OH)
- …as well as some experience in the following areas: acute care, utilization management (UM)/medical necessity review, InterQual knowledge, and discharge ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...and actions taken on member medical records in health management systems according to utilization management… more
- Bon Secours Mercy Health (Youngstown, OH)
- …* Protects the safety and privacy of all persons. * Understanding and utilization of office and clinical technologies. **Working Conditions** Periods of high ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of… more
- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more