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Manulife

Suitability Review Specialist

Delaware, OH · Remote

$73K - $122K/yr

... reviewing new business submissions and replacement transactions involving annuity and life insurance products to ensure compliance with regulatory requirements, suitability standards, and company ...

CFA Institute

Coordinator, Quality Review

London, OH · On-site

$60K - $80K/yr

Coordinator, Quality Review About the Role The Coordinator, Quality Review ensures the accuracy, consistency, and quality of curriculum, certificates, and exam materials across CFA Institute programs.

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Elevance Health

Psychologist Reviewer - ABA

Columbus, OH · On-site

$93K - $167K/yr

Psychologist Reviewer - ABA Work location - Virtual This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...

2M Quality, LLC

Be Seen First

New Home Quality Reviewer

Gahanna, OH · On-site

$25 - $45/hr

Entering review results online using your own tablet while on the job site. Training will be provided on how to enter a Quality Review Report in the report database. Reviewers are not required to ...

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Care Review Nurse

Careers Integrated Resources Inc

Columbus, OH • On-site

Other

Posted 4 days ago

Job description

Care Review Nurse

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Medicaid Division

Duties: Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses working at the facilities members are being care for, will be sending over clinical information to be reviewed by the Care Review Clinician. Therefore, this agent will not be traveling and will be reviewing information at the office.

Qualifications

Background hospital utilization management. Insurance utilization manager/review and millemen experience (MCG). No case managers if that is their only experience. Must have utilization review or management. Utilization review (1 year +), past hospital experience (3-4 years of experience, less experience is ok if they have more utilization review experience). Potential for longer term dependent on enrollment workers will be doing concurrent inpatient review MUST have one of the following at least - utilization review in hospital setting nurses who are used to doing both production and review work.

All your information will be kept confidential according to EEO guidelines.

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