Care Review Nurse
Columbus, OH · On-site
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 ...
Columbus, OH · On-site
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 ...
Columbus, OH · On-site
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 ...
Columbus, OH · On-site
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 ...
Columbus, OH · On-site
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 ...
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Columbus, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Columbus, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Powell, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Powell, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Communicate with physicians to schedule peer to peer reviews. Accurately report denials. SUPERVISORY RESPONSIBILITIES: Manage the work of others, including planning, assigning, scheduling and ...
Communicate with physicians to schedule peer to peer reviews. Accurately report denials. SUPERVISORY RESPONSIBILITIES: Manage the work of others, including planning, assigning, scheduling and ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre ...
De Novo, a boutique staffing and recruitment agency, is currently seeking a personal injury attorney with discovery review experience to work directly with one of our clients. This is a contract to ...
Quick apply
De Novo, a boutique staffing and recruitment agency, is currently seeking a personal injury attorney with discovery review experience to work directly with one of our clients. This is a contract to ...
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 ...
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 ...
Columbus, OH · On-site
Care Review Clinician 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 ...
Columbus, OH · On-site
Care Review Clinician 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 ...
Delaware, OH · Remote
$73K - $122K/yr
Conduct reviews, monitoring activities, and audits to identify unusual, suspicious, or potentially non-compliant activity; investigate findings and escalate concerns as appropriate. * Provide ...
Delaware, OH · Remote
$73K - $122K/yr
Conduct reviews, monitoring activities, and audits to identify unusual, suspicious, or potentially non-compliant activity; investigate findings and escalate concerns as appropriate. * Provide ...
$60K - $80K/yr
You'll conduct detailed reviews of educational content across formats - including Canvas courses, PDFs, and eBooks - to catch and report errors before they reach learners. You'll also help build and ...
Posted today
$60K - $80K/yr
You'll conduct detailed reviews of educational content across formats - including Canvas courses, PDFs, and eBooks - to catch and report errors before they reach learners. You'll also help build and ...
Posted today
Reviews medical records/case file, writes a decision that is clear, concise, and impartial and supports the determination made, and documents review * Makes sound, independent decisions based on ...
Reviews medical records/case file, writes a decision that is clear, concise, and impartial and supports the determination made, and documents review * Makes sound, independent decisions based on ...
Columbus, OH · On-site
$50 - $55/hr
Perform clinical reviews of medical necessity appeals involving denied authorizations and prior authorization decisions. * Review medical records, clinical information, medical codes, authorization ...
New
Quick apply
Columbus, OH · On-site
$50 - $55/hr
Perform clinical reviews of medical necessity appeals involving denied authorizations and prior authorization decisions. * Review medical records, clinical information, medical codes, authorization ...
New
Columbus, OH · On-site
Care Review Processor 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 ...
Columbus, OH · On-site
Care Review Processor 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 ...
Columbus, OH · On-site
$23.76 - $51.49/hr
Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization Reviews. SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are ...
Columbus, OH · On-site
$23.76 - $51.49/hr
Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization Reviews. SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are ...
$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 ...
$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 ...
Be Seen First
Gahanna, OH · On-site
$25 - $45/hr
Driving to construction sites and conducting quality reviews on the day it is scheduled. Work may be started anytime during the day between 8 am to 3:30 pm. Reports are submitted on site ...
Quick apply
Be Seen First
Gahanna, OH · On-site
$25 - $45/hr
Driving to construction sites and conducting quality reviews on the day it is scheduled. Work may be started anytime during the day between 8 am to 3:30 pm. Reports are submitted on site ...
De Novo, a boutique staffing and recruitment agency is currently seeking a Discovery Review Contract Attorney with experience in the area of personal injury and/or mass tort/class action to work ...
Quick apply
De Novo, a boutique staffing and recruitment agency is currently seeking a Discovery Review Contract Attorney with experience in the area of personal injury and/or mass tort/class action to work ...
$6.25 - $13.46
2% of jobs
$13.46 - $20.67
19% of jobs
$21.50 is the 25th percentile. Wages below this are outliers.
$20.67 - $27.88
36% of jobs
$27.88 - $35.10
14% of jobs
$36.61 is the 75th percentile. Wages above this are outliers.
$35.10 - $42.31
20% of jobs
$42.31 - $49.52
2% of jobs
$49.52 - $56.73
1% of jobs
$56.73 - $63.94
1% of jobs
$63.94 - $71.15
3% of jobs
$71.15 - $78.37
2% of jobs
$78.37 - $85.58
0% of jobs
$6
$35
$85
For Reviews jobs, the most frequently searched job titles are:
The top searched job categories for Reviews jobs are:
Cities with the most Reviews job openings:
States with the most job openings for Reviews jobs include:
The most popular types of Reviews jobs are:

Other
Posted 4 days ago
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 DescriptionWorks 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.
QualificationsBackground 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.