Clinical Claim Review Nurse - Columbus

+Job summary · We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. · +Hospital Utilization Management. · Insurance Utilization Manager/Review and Millemen Experience (MCG). · +Review cases for in patients/in hos ...

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS).SURS helps review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate payments to providers. · ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be part of their Surveillance/Utilization Review Section. As a Clinical Review Nurse Supervisor, responsibilities include managing hospital utilization contracts, reviewing medical records, supervising st ...

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS). SURS is charged with helping the agency review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate pa ...

We're building a world of health around every individual — shaping a more connected, · convenient and compassionate health experience.At CVS Health, you'll be surrounded by passionate colleagues who care deeply, · innovate with purpose, hold ourselves accountable and prioritize ...

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to supervise clinical review nurses in identifying fraud, waste and abuse in the Medicaid program. · Helping to manage an over $7 million/year hospital utilization contract · Reviewing necessary medical reco ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

Position Qualifications:  · Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section of Revised Code and all of the following bulleted criteria\:   · 24 mos. exp. in pediatric nursing, wh ...

Utilization review nurse responsible for ensuring high-quality and medically necessary care for patients. Maintains efficient methods of reviewing medical necessity criteria to ensure appropriateness of hospital admissions. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. The Nurse Reviewer I is responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · Conducts initia ...

The Registered Nurse (RN) - Transplant Utilization Review is responsible for reviewing and processing medical service requests for members of Quantum Health's employer groups in an inpatient setting across the transplant continuum. · Assess and review all requests for inpatient t ...

The Pre-Certification Review Nurse – Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications, · reviewing and processing all requests for specialty medications · ...

The Pre-Certification Review Nurse – Pharmacy will review and process coverage determinations and utilization management reviews for specialty medications. · ...

+The Manager UR Operations is responsible for managing the execution of Quantum's Utilization Review delivery. · This leader will have primary accountability for performance management escalation triage audit presentation. · Provide direct leadership subject matter expertise for ...

The Pre-Certification Review Nurse – Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications. · ...

The Manager, UR Operations is responsible for managing the execution of Quantum's Utilization Review delivery. · ...

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr- If you have questions while submitting an application, please review these frequently asked questions. · Current Employees And Students · If you are currently employed or ...

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr- If you have questions while submitting an application, please review these frequently asked questions. · Current Employees And Students · If you are currently employed or ...

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr- If you have questions while submitting an application, please review these frequently asked questions. · Current Employees and Students: · If you are currently employed o ...