... and 30% remote. The patient members that they will be assessing are dual eligible Medicare ... staff, utilization management staff, health plan partners and contracted providers. RN Field ...
... and 30% remote. The patient members that they will be assessing are dual eligible Medicare ... staff, utilization management staff, health plan partners and contracted providers. RN Field ...
Clinical Financial Case Mgr - RN
Columbus, OH · On-site +1
... Utilization Management, Peer to Peer processes, complex billing scenarios, audits (governmental ... Location: Remote Location Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final ...
Clinical Financial Case Mgr - RN
Columbus, OH · On-site +1
... Utilization Management, Peer to Peer processes, complex billing scenarios, audits (governmental ... Location: Remote Location Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final ...
Director of Managed Care Remote Position Job Summary: We are seeking an experienced, detail-driven ... and utilization management across six skilled nursing facilities in Arkansas and Ohio . As a key ...
Quick apply
Director of Managed Care Remote Position Job Summary: We are seeking an experienced, detail-driven ... and utilization management across six skilled nursing facilities in Arkansas and Ohio . As a key ...
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... case management team. Maintain contact with internal clinical staff for transfer of cases for ...
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... case management team. Maintain contact with internal clinical staff for transfer of cases for ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development. * Lead cross ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development. * Lead cross ...
Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed
Dayton, OH · On-site +1
$62K - $100K/yr
Utilization Management/Utilization Review experience preferred * Medicaid/Medicare/Commercial ... Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required * MCG ...
Clinical Care Reviewer II - RN - IN MCD - IN or MSL Licensed
Dayton, OH · On-site +1
$62K - $100K/yr
Utilization Management/Utilization Review experience preferred * Medicaid/Medicare/Commercial ... Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required * MCG ...
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH · Remote
$71K - $89K/yr
RN Hospice Workflow Specialist / Weekend Manager (Remote) Position Summary The RN Hospice Workflow ... Essential Duties and ResponsibilitiesWeekend Clinical Operations Management * Provide remote ...
Quick apply
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH · Remote
$71K - $89K/yr
RN Hospice Workflow Specialist / Weekend Manager (Remote) Position Summary The RN Hospice Workflow ... Essential Duties and ResponsibilitiesWeekend Clinical Operations Management * Provide remote ...
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
Remote Nurse Practitioner
OH · Remote
Care Management * Active clinical licensure -- any of the following: * Nurse Practitioner (NP) - ... and remote monitoring * Collaborate with physicians, RNs, social workers, therapists, caregivers ...
Quick apply
Remote Nurse Practitioner
OH · Remote
Care Management * Active clinical licensure -- any of the following: * Nurse Practitioner (NP) - ... and remote monitoring * Collaborate with physicians, RNs, social workers, therapists, caregivers ...
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
Registered Nurse - Referral Care Coordination
Columbus, OH · On-site +1
$70K - $148K/yr
The RCT RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ...
Registered Nurse - Referral Care Coordination
Columbus, OH · On-site +1
$70K - $148K/yr
The RCT RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ...
Nurse Advocate - Greater Cleveland area
Cleveland, OH · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Cleveland, Ohio Area Job Summary: We are ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Nurse Advocate - Greater Cleveland area
Cleveland, OH · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Cleveland, Ohio Area Job Summary: We are ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Cardiology, medication management and reconciliation, Pulmonary and Diabetes. * Record visit ... Provide remote employee health evaluations for minor ailments QUALIFICATIONS KNOWLEDGE/SKILLS ...
Cardiology, medication management and reconciliation, Pulmonary and Diabetes. * Record visit ... Provide remote employee health evaluations for minor ailments QUALIFICATIONS KNOWLEDGE/SKILLS ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Manage patient census with a resolution-driven approach to close gaps in clinical and non-clinical ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Manage patient census with a resolution-driven approach to close gaps in clinical and non-clinical ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Manage patient census with a resolution-driven approach to close gaps in clinical and non-clinical ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Manage patient census with a resolution-driven approach to close gaps in clinical and non-clinical ...
... resource utilization and variable acuity across the transplant continuum. Management begins at ... remote work. What you'll do (Essential Responsibilities) Identifyand assess members with the ...
... resource utilization and variable acuity across the transplant continuum. Management begins at ... remote work. What you'll do (Essential Responsibilities) Identifyand assess members with the ...
Healthcare Data Analyst (Remote)
Findlay, OH · On-site +1
... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ... Degree in nursing, health care, informatics, or information systems or related field or ...
Healthcare Data Analyst (Remote)
Findlay, OH · On-site +1
... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ... Degree in nursing, health care, informatics, or information systems or related field or ...
... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ... Degree in nursing, health care, informatics, or information systems or related field or ...
... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ... Degree in nursing, health care, informatics, or information systems or related field or ...
Telehealth Provider, NP, Remote, Per Diem
Cincinnati, OH · Remote
$76.33/hr
... systems through the utilization of data demonstrating program effectiveness and success ... Performs other duties as assigned and modified at manager's discretion. KNOWLEDGE, SKILLS AND ...
Telehealth Provider, NP, Remote, Per Diem
Cincinnati, OH · Remote
$76.33/hr
... systems through the utilization of data demonstrating program effectiveness and success ... Performs other duties as assigned and modified at manager's discretion. KNOWLEDGE, SKILLS AND ...
Remote Cvs Utilization Management Nurse information
What is the difference between Remote Cvs Utilization Management Nurse vs Remote Cvs Case Manager?
| Aspect | Remote Cvs Utilization Management Nurse | Remote Cvs Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification |
| Work Environment | Utilization review teams, insurance companies | Patient advocacy, care coordination teams |
| Employer & Industry | Health insurance, managed care organizations | Health insurance, healthcare providers |
Both roles require RN licensure and related certifications, but the Utilization Management Nurse focuses on reviewing medical necessity and approving services, while the Case Manager emphasizes coordinating patient care and discharge planning. Understanding these differences helps job seekers find the right fit within the healthcare and insurance industries.
What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Ohio?
The most popular types of Cvs Utilization Management Nurse jobs in Ohio are:
What are popular job titles related to Remote Cvs Utilization Management Nurse jobs in Ohio?
For Remote Cvs Utilization Management Nurse jobs in Ohio, the most frequently searched job titles are:
- Manager Utilization Management
- Evening Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Seasonal Remote Hedis Review Nurse
- Remote Utilization Review Rn
- Remote Utilization Management
- Night Utilization Review Nurse
- Utilization Review Nurse
- Home Based Utilization Review Nurse
- Per Diem Utilization Review Nurse
What job categories do people searching Remote Cvs Utilization Management Nurse jobs in Ohio look for?
The top searched job categories for Remote Cvs Utilization Management Nurse jobs in Ohio are:
What cities in Ohio are hiring for Remote Cvs Utilization Management Nurse jobs?
Cities in Ohio with the most Remote Cvs Utilization Management Nurse job openings:
Full-time
Re-posted 11 days ago
Job description
Company Description
Are you an experienced Administrative Assistant looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!
Job Description
RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. RN Field Behavioral Health Case Manager assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the High Risk Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.
Daily Responsibilities:
RN Field Behavioral Health Case Manager will be responsible for the Lucas County patient members'
Work telephonically with patients identified as high risk to identify needs, set goals and implement action steps towards achieving goals.
Empower patients to help them improve their quality of life.
Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.
RN Field Behavioral Health Case Manager participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.
RN Field Behavioral Health Case Manager will assist with the implementation of policies and procedures regarding case management and utilization management functions.
Working with these members to identify needs and goals to achieve improved quality of life.
Maintain HIPAA compliance.
Qualifications
Requirements:
MUST have a valid RN License in the State of OH
3 years of Behavioral Health experience
3-5 years of case and/or utilization management experience.
CCM (Certified Case Manager) or other clinical certification preferred
Hours for this Position:
Monday - Friday 8 am - 5 pm.
Advantages of this Opportunity:
Competitive salary
Growing Company
Medical benefits go into effect 30 days after start date
Additional Information
If you are interested in applying to this position, please contact Shanna Ramirez, (407) 636-7030 ext. 170 and click the Green "I'm Interested" Button to email your resume.
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003