- CVS Health (Columbus, OH)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** 2+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH **Schedule** - Mon-Fri Standard… 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 ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- CVS Health (Columbus, OH)
- …procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors ... meet quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more
- CenterWell (Columbus, OH)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- CenterWell (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
- CVS Health (Columbus, OH)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Elevance Health (Cincinnati, OH)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... 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
- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management . Partners with Social Workers to refer ... A minimum of three years experience as a registered nurse in acute care for adult or pediatric patients...be taken into consideration. . Professional experience with case management , utilization review, or discharge planning highly… more
- Sharecare (Columbus, OH)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
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