Average salary: $88,633 /yearly
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$29.05 - $67.97 per hour
...healthcare guidelines. Candidates should possess at least 2 years of clinical nursing experience, along with familiarity with medical coding and utilization review. Competitive benefits and a pay range of $29.05 - $67.97 per hour are offered. #J-18808-Ljbffr Molina HealthcareSuggestedHourly pay- ...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
$29.05 - $67.97 per hour
...healthcare organization in Cleveland, Ohio, is seeking a clinical review professional to support medical claims and appeals reviews. The... ...have at least 2 years of clinical nursing experience, an active RN license, and proficiency in coding. Responsibilities include conducting...SuggestedHourly pay- ...JOB SUMMARY ~ Performs the four key functions of case management: Utilization review, Resource management, Managing the continuum of care, and Clinical documentation management. Responsible for facilitating appropriate length of stay and reimbursement for all hospital...Suggested
Trinity Health System
Steubenville, OH3 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
- 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 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
- RN, Registered Nurse- Manager, Utilization Review Operations Location: This position is located at our Dublin, OH campus. Who we are: Founded in 1999 and headquarted in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that...SuggestedCasual workWork at office
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
- ...experience doesn’t match every requirement. About the role The Utilization Review Nurse is responsible for reviewing and processing medical... ...Credentials: Current and active license as a Registered Nurse (RN) in the state of Ohio. Licensed Practical Nurses (LPNs) currently...SuggestedWork at office
- ...Utilization Review Specialist Location: Highland Springs in Highland Hills, OH Schedule: Full Time, Day Shift Your experience matters At Highland Springs, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care...SuggestedFull timeTemporary workPart timeFlexible hoursDay shift
LifePoint Health
Beachwood, OH3 days ago - ...~ Every third weekend rotation off-site; less than 3 hours per scheduled weekend Duties and Key Responsibilities The Utilization Review Coordinator reviews and clarifies patient status, applies initial and continued stay criteria to determine medical necessity,...SuggestedPart timeLocal area
Grand Lake Health System
Ohio2 days ago $40 - $45 per hour
...Immediate Hiring for “Remote Clinical Review Nurses” Job Description: Review approximately... ...cases. Qualifications 3 years of utilization management, concurrent review, prior authorization... ..., and discharge planning. Active RN Compact License. If you are Interested, kindly...SuggestedContract workTemporary workImmediate startRemote workActalent
Columbus, OH3 days ago- ...interdisciplinary team in the provision of patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is responsible for an initial clinical review at the point of patient entry...Night shiftRotating shift
The MetroHealth System
Cleveland, OH4 days ago $76k - $85k
...sector. To learn more, visit . PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for utilizing... ...environment, Medicaid or hospital utilization management RN required Working Conditions ~ Remote The above is...For contractorsH1bWork at officeLocal areaRemote workPublic Consulting Group
Columbus, OH2 days ago$18 - $20 per hour
A leading claims management company, located in Columbus, Ohio, is seeking a Utilization Review Coordinator responsible for assigning utilization review requests and verifying data. Ideal candidates should have a high school diploma and two years of administrative experience...Hourly pay- ...navigation organization is seeking a Registered Nurse Manager to oversee Utilization Review operations at their Dublin, OH campus. The ideal candidate will possess a clinical leadership background, an active RN license in Ohio, and experience in utilization management. The...
$29.1 - $62.32 per hour
...patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive... .... Required Qualifications Active, unrestricted RN license in your state of residence with...Remote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- A leading healthcare provider in Cleveland seeks a Utilization Review Nurse responsible for supporting patient care and improving organizational... ...position requires a Bachelor's degree in Nursing, a current RN license in Ohio, and at least five years of clinical experience...
- ...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...Extra income
Dane Street
Delaware, OH10 hours ago - A healthcare organization is seeking a remote Utilization Management Nurse Consultant to manage medical review cases and ensure timely patient care. The role requires an active RN license and at least 3 years of clinical experience, with expertise in utilization review...Remote jobFull time
$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...Work at officeLocal areaRemote workVisa sponsorshipWork visaPrime Therapeutics
Columbus, OH10 hours 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....Local area
Christian Healthcare Ministries
Barberton, OH1 day ago $29.05 - $67.97 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Hourly payWork experience placementWork at office- 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...
- ...physical assessment, interview and chart review. Discusses resident care needs with care... ...for monitoring of Medicare days and RUGs utilization in the absence of the Care Management... ...Qualifications: Registered Nurse, RN or Licensed Practical Nurse AANC certification...Full time
The Laurels of Huber Heights
Huber Heights, OH10 hours 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
- ...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...Full timeFlexible hours
The Laurels of Walden Park
Columbus, OH10 hours ago
