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Utilization Review Specialist-PRN
Acadia External
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Franklin Township, OH, 43223
... Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified ... Facilitate peer review calls between facility and external organizations. Initiate and complete the formal appeal process ... - Jun 14
Clinical Authorization Review Nurse (Medicaid Health Systems
Ohio Department of Commerce
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Clinton Township, OH, 43224
What You Will Do At ODM: Working Title: Clinical Authorization Review Nurse Classification : Medicaid Health Systems ... in prior authorization and service authorization oversight and utilization activities Reviewing both physical and behavioral ... - Jun 17
Clinical Review Clinician - Appeals
Spectraforce Technologies
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Clinton Township, OH, 43224
... - Utilization review nurse, appeal review nurse and direct patient care experience. * Performance indicators: (Metrics: 10 to 15 appeals a day after training. Not letting any items in work queues go over compliance Turn Around Time.) * Best vs. ... - Jun 24
Clinical Authorization Review Nurse (Medicaid Health Systems
ohio.gov
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Franklin County, OH
Schedule: Full-time What You Will Do At ODM: Working Title: Clinical Authorization Review Nurse Classification: Medicaid ... in prior authorization and service authorization oversight and utilization activities Reviewing both physical and behavioral ... - Jun 12
Clinical Review Nurse - Prior Authorization
Spectraforce Technologies
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Clinton Township, OH, 43224
... Care manager or clinical nursing experience, Word, Excel, Virtual meeting skills, MS outlook and EMR systems Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse experience; ... - Jun 24
Physician Advisor, Utilization Review/Management
Sutter Health
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Clinton Township, OH, 43224
... Comprehensive knowledge of Utilization Review, levels of care, and observation status. Some awareness of healthcare reimbursement systems: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Patient Processing Service (PPS) ... - Jun 24
Clinical Review Nurse - Prior Authorization
Centene Corporation
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Clinton Township, OH, 43224
... to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties ... - Jun 26
Clinical Authorization Review Nurse (Medicaid Health Systems
Medicaid
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Columbus, OH, 43215
What You Will Do At ODM: Working Title: Clinical Authorization Review Nurse Classification\: Medicaid Health Systems ... in prior authorization and service authorization oversight and utilization activities Reviewing both physical and behavioral ... - Jun 25
Clinical Review Nurse - Prior Authorization
Actalent
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Clinton Township, OH, 43224
... Educate providers and internal teams on utilization processes to promote high-quality, cost-effective care. Identify and share opportunities for process improvement in the authorization review workflow. Perform other duties as assigned. Comply with ... - Jun 24
Utilization Management Clinical Consultant (Must reside in Ohio)
CVS Health
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Clinton Township, OH, 43224
... based on business needs, including occasional rotating weekend and holiday schedules **Preferred Qualifications** + Utilization review experience strongly preferred + Behavioral health experience + Experience in a behavioral health inpatient setting ... - Jun 26