- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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...by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must be… more
- CVS Health (Columbus, OH)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and ... available with Holiday, Weekend, and late rotations. **Required Qualifications** + Registered Nurse + Must have active current and unrestricted RN licensure in state… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 and… more
- Lincoln Financial (Columbus, OH)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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...of Nursing + Current state licensure as a Registered Nurse (RN) + Basic Life Support (BLS) Certification through… more
- CVS Health (Columbus, OH)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is ... external constituents in the coordination and administration of the utilization /benefit management function **Required Qualifications** + Licensed independent… more
- Humana (Columbus, OH)
- …put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are… more
- Elevance Health (Mason, OH)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more