Average salary: $88,633 /yearly
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- ...evidence based clinical guidelines. Conducts prior authorization reviews to determine financial responsibility Qualifications 2 years... ...with Hospital Nursing (Med-Surg, ER) Well versed in Utilization Management-Must be able to determine elective vs urgent request...SuggestedPrivate practice
- ...compliance with regulations, analyzing clinical requests, and conducting prior authorization reviews. The ideal candidate should have 2 years of inpatient nursing, familiarity with Utilization Management, and experience with ICD10 and CPT coding. Interested candidates should...Suggested
$52.26 - $81.13 per hour
...Description The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing...SuggestedMinimum wageFull timeLocal areaShift workProvidence Health and Services
Bellevue, OH2 days ago- ...and appropriateness of treatment setting reviews to ensure compliance with applicable criteria... ...Requirements: Must have clear and active RN license in the state of OH AS/BS in... ...care Experience with medical record review/utilization review/utilization management Additional...SuggestedContract workPrivate practiceMonday to Friday
- ...experience doesn’t match every requirement. About the role The Utilization Review Nurse is responsible for reviewing and processing medical... ...Licensure: Current and active license as a Registered Nurse (RN) in the state of Ohio. Licensed Practical Nurses (LPNs) currently...SuggestedWork at office
- ...healthcare navigation organization in Dublin, OH is seeking a Utilization Review Nurse responsible for reviewing medical services requests for... ...clinical experience in a hospital setting and be licensed as an RN in Ohio. The position offers hybrid work flexibility,...Suggested
- A healthcare navigation organization is seeking a Utilization Review Nurse in Dublin, OH. The role involves reviewing inpatient medical service... ...discharge planning for patients. Candidates should have a current RN license in Ohio, with a minimum of 2 years of clinical...SuggestedWork at office
- ...healthcare navigation organization in Dublin, OH is looking for a Utilization Review Nurse to assess and process medical service requests for... ...collaborating with healthcare providers. Candidates should have an active RN license in Ohio and at least 2 years of clinical experience....Suggested
RN, Registered Nurse- Pre-Certification Pharmacy Review (Utilization Management Pharmacy experi[...]
RN, Registered Nurse - Pre-Certification Pharmacy Review 1 day ago Be among the first 25 applicants. Direct message the job poster from Quantum Health. Location... ...and processing coverage determinations and utilization management reviews for specialty medications, to include...SuggestedFull timeWork at office- A national healthcare staffing firm is seeking a dedicated Registered Nurse to manage utilization review processes. This RN will ensure quality and cost-effective healthcare by assessing medical necessity, coordinating care, and managing appeals for denied services. Candidates...Suggested
- ...Utilization Review Nurse/Case Management Part-Time On-site St. Marys, OH 45885, USA Description Hours of Job: ~ Part Time - 40 hours/5 days per pay period ~7:30 AM-4:00 PM ~ Every third weekend rotation off-site; less than 3 hours per scheduled weekend...SuggestedPart timeLocal area
Grand Lake Health System
Ohio14 hours ago $62.7k - $100.4k
Job Summary Job Summary Clinical Care Reviewer II is responsible for processing medical necessity... ...of an accredited registered nursing (RN) degree program required Three (3) years... ...care or home health experience preferred Utilization Management/Utilization Review experience...SuggestedHourly payWork at office- ...A healthcare review organization seeks a Physician Reviewer/Advisor in Delaware, Ohio. This role involves utilizing clinical expertise to review insurance appeals and claims while ensuring compliance with established guidelines. Responsibilities include thorough medical...SuggestedExtra income
Dane Street
Delaware, OH3 days ago $90.87 - $154.33 per hour
...build the future of pharmacy with us. Job Title Physician Clinical Reviewer- Pediatric Neurology- REMOTE Responsibilities Reviews cases in... ...Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency...SuggestedWork at officeLocal areaRemote workVisa sponsorshipWork visaPrime Therapeutics
Columbus, OH2 days ago- ...The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting... ...reasoning. Evidence-based decision making – Utilizes research and guidelines to support review... ...healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required....SuggestedLocal area
Christian Healthcare Ministries
Barberton, OH7 hours ago - A leading IT services company is seeking a candidate for a medical review role in Columbus, Ohio. The position involves reviewing Case Report Forms and managing various clinical studies, with a focus on adverse event reporting and medical communication. Candidates should...
- ...consultant, access a secure portal to retrieve and work clinical cases; review each set of case records for the clinical history, diagnoses,... ...to ensure accurate and defensible assessments. - Utilize understanding of Office of Personnel Management (OPM) hiring...Minimum wageContract workTemporary workWork experience placementWork at office
MAXIMUS
Cleveland, OH3 days ago - A healthcare company seeks a Utilization Management / Medical Management Nurse with strong nursing judgment for complex case reviews. This role allows for full-time remote work, with responsibilities including reviewing cases for medical necessity and consulting with healthcare...Remote jobFull time
- ...The Power of Every One. Job Title RN - SANE/Forensic Nursing Location... ...assessments under the supervision of a LIP. Utilize thorough knowledge of anatomy and body... ...of Health Care Administration: Please review the Equal Employment Opportunity poster....ReliefWork at officeShift workNight shift
Cleveland Clinic
Pepper Pike, OH2 days ago - ...Summary The Aultman Registered Nurse (RN) is a professional nurse that provides... ...AHA) training in Basic Life Support (BLS) utilizing Resuscitation Quality Improvement (RQI) is... .... ~ Responsible for timely review of emails, department communications and...Shorter hoursShift workWeekend work
Aultman Health Foundation
Canton, OH3 days ago $90.87 - $154.33 per hour
...A leading pharmacy benefit manager is seeking a Physician Clinical Reviewer - Urology to join their utilization management team. The role involves medical review of service requests and interaction with healthcare providers. Ideal candidates need a DO, MBBS, or MD and...Remote workPrime Therapeutics
Columbus, OH4 days ago$90.87 - $154.33 per hour
...A healthcare company is seeking a Physician Clinical Reviewer specializing in Endocrinology to conduct remote medical reviews. Candidates... ...requests, communicating with providers, and adhering to utilization management policies. This position offers a competitive salary...Remote workPrime Therapeutics
Columbus, OH1 day ago- ...Assesses resident through physical assessment, interview and chart review.Discusses resident care needs with care givers, including... ...maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.Remains current...Flexible hours
The Laurels of Walden Park
Columbus, OHa month ago - ...Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And... ...For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or Directed...Temporary workFlexible hours
Yale New Haven Health
Milford, OH2 days ago - ...Group Float position, multi-state/compact RN licenses Dialysis Experience... ...on the Hemodialysis Treatment Sheet. Reviews, transcribes, and enters physician lab orders... ...alternate lab. Ensures correct labs tubes are utilized for prescribed lab specimens and that lab...ReliefImmediate startShift work
Fresenius Medical Care
Toledo, OH7 hours ago $60k
...long-term outcomes for patients. POSITION SUMMARY: The Utilization Review (UR) Specialist will independently facilitate clinical reviews... ...Master’s Degree in related field preferred. Licensure: LPN, RN, LSW, LPC, MFT, LISW, LPCC or LMFT required. Skills:...Price workFull timeTemporary workFlexible hours$44.92 per hour
...and their families, across the United States. Job Summary: The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office equipment...Hourly payFull timeFor contractorsWork at officeLocal areaMonday to FridayShift workDay shiftDecypher
Dayton, OH1 day ago$90.87 - $154.33 per hour
A healthcare organization is seeking a Physician Clinical Reviewer specializing in Pediatric Rheumatology. This remote role involves... ...reviews, interaction with physicians, and ensuring compliance with utilization management guidelines. Candidates must have a DO, MBBS, or MD...Remote job- ...completion of the Annual Standing Order Review and Internal Classification of Disease (ICD... ...clinic financials including efficient utilization of supplies or equipment and regular profits... ...of an accredited School of Nursing (RN). Current appropriate state licensure....
Fresenius Medical Care
Garfield Heights, OH5 days ago $2,222 per week
...Registered Nurse (RN) | Oncology Location: Columbus, OH Agency: Prime Staffing... ...department s needs. Shift assignments are reviewed every 4-week scheduling period, but changes... ...clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing...Permanent employmentContract workTemporary workLocal areaImmediate startShift workNight shiftWeekend workTravel Nurse Source
Columbus, OH2 days ago
