Utilization review nurse jobs in Ohio - 991 jobs

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: Provides general nursing care to patients and families throughout the continuum of care in diverse, acute health care settings. (Department has scheduled staff to operate 24/7/365). The RN accountable for the practice of nursing as defined by the Ohio Board of Nursing. The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive personnel (UAPs) using the criteria written in the Ohio Nurse Practice Act. According to department policies and nursing care standards, provides professional nursing care services to patients. Responsible for assessing, planning, implementing, and evaluating nursing care provided to assigned patients. Responsibilities And Duties: Assessment/Diagnosis - Performs initial, ongoing, and functional health status assessment as applicable to the population and or individual (30%). Outcomes Identification/Planning - Based on nursing diagnoses and collaborative problems, documents planned nursing interventions to achieve outcomes appropriate to patient needs (30%). Implementation/Evaluation - Evaluates and documents response to nursing interventions and achievement of outcomes at appropriately determined intervals; as part of a multidisciplinary team, revises plan of care based on evaluative data (20%). Leadership - Actively participates in process improvement activities to achieve targeted measures of clinical quality, customer satisfaction, and financial performance (10%). Operations (10%). Minimum Qualifications: Associate's Degree: NursingBLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing Additional Job Description: MINIMUM QUALIFICATIONS Current Registered Nurse license from the State of Ohio and/or current Registered Nurse license in good standing with a multi-state compact state. BLS certification BSN required at 5 years of employment Work Shift: Variable Scheduled Weekly Hours : As Needed Department Emergency Department Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

**Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ **Schedule:** **9:30am-6:00pm local time,** **with rotating weekends.** **New Grads are encouraged to apply!** The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. + Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. + Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners with more senior colleagues to complete non-routine reviews. + Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. **How you will make an impact:** + Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. + Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. + Follows-up to obtain additional clinical information. + Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. **Minimum Requirements:** + AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. + Current unrestricted RN license in applicable state(s) required. **Preferred Skills, Capabilities, and Experiences :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or call center experience preferred. + Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12/hr - $56.77/hr Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois, District of Columbia In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

**Become a part of our caring community and help us put health first** Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active Unrestricted RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Valid driver's license and/or dependable transportation necessary + Travel for offsite Orientation 2 to 8 weeks + Travel to offsite meetings up to 6 times a year as requested + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers + Available for On Call weekend/holiday rotation if needed **Role Desirables** + Education: BSN or bachelor's degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Additional Information** We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-18-2026 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

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! Job Description Daily Responsibilities: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting Applies clinical knowledge to work with facilities and providers for care coordination Works with medical directors in interpreting appropriateness of care and accurate claims payment May also manage appeals for services denied Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract Facilitates member care transition through the healthcare continuum Refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications Hours for this Position: Monday-Friday (40 hours/week) Advantages of this Opportunity: Competitive salary, negotiable based on experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Weekly deposit options Qualifications Requirements: Must have clear and active RN license in the state of OH AS/BS in Nursing Experience in acute clinical care Experience with medical record review/utilization review/utilization management Additional Information Are you an experienced Registered Nurse with Utilization review experience 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! Interested in hearing more about this great opportunity? Please click apply or call Amanda Hammer at 407-636-7030 ext.201 for additional details.

RN Case Management / Utilization Review Status: Full-Time Shift: Day shift- Monday through Friday The RN Case Management/Utilization Review role supports Adena's integrated Case Management Program, combining utilization review, discharge planning, and resource management. This position ensures patients receive care in the most appropriate setting based on clinical assessment, medical necessity, and efficient use of resources. The role collaborates with the interdisciplinary team to improve quality outcomes, manage length of stay, and reduce unnecessary costs. Required Qualifications Current Ohio RN license Bachelor's Degree in Nursing (BSN) 3-5 years acute hospital nursing experience Case Management Certification (CCMC) required within 3 years of hire Preferred Qualifications 3-5 years acute hospital case management experience Utilization review experience Knowledge of payer and regulatory guidelines Outstanding Benefits Package: Low-Deductible Health Plans - Quality coverage with affordable costs. Pet Insurance - Because your furry family members deserve care too. Public Service Loan Forgiveness (PSLF) Eligibility - Helping you work toward a debt-free future. Work with purpose - help patients and families during their most vulnerable times Collaborative team - be part of a multidisciplinary group that values your voice Supportive culture - compassion, respect, and dignity drive everything we do Ready to bring hope, healing, and support to those who need it most? Apply today and become a trusted resource in your community.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Nurse Case Manager - Internal (Medical Review Nurse - PN 20014026) (250009CG) Organization: HealthAgency Contact Name and Information: Gayla. A will contact you if selected for interview.Unposting Date: OngoingWork Location: Health Department Building 246 North High Street 1st Floor Columbus 43215Primary Location: United States of America-OHIO-Franklin County Compensation: $34.96Schedule: Full-time Work Hours: Monday - Friday; 8am - 5pmClassified Indicator: ClassifiedUnion: 1199 Primary Job Skill: NursingTechnical Skills: Health Administration, Nursing, Public Health, Public Relations, Medical records Professional Skills: Analyzation, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communication Agency OverviewNurse Case Manager- Internal (Medical Review Nurse) About Us:Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.The Bureau of Maternal, Child, and Family Health (BMCFH)/ Complex Medical Help (CMH) is organized to support families by improving birth outcomes and the health status of women, infants, children, and youth, including children and youth with complex health care needs. Using data and proven practice, the bureau's programs support the delivery of direct services, linkages and referrals, population-based supports, program evaluation, education, monitoring and quality oversight, and policy and systems development. Job DutiesWhat You'll Do:Are you a compassionate and detail-oriented nurse looking to make meaningful impact in the lives of children with special care needs? This role offers a dynamic blend of clinical decision-making, case management, community engagement, and administrative support-ideal for nurses who thrive in both independent and collaborative environments. Duties Include: Clinical and Case Management: Independently assess medical applications and determine eligibility for CMH services. Authorize or deny diagnostic, treatment, and service coordination based on medical data and program guidelines. Interpret medical plans for treatment and develop appropriate care strategies. Monitor ongoing service needs and effectiveness, ensuring compliance with HIPAA and CMH policies. Coordinate complex treatment plants with other state and federal programs. Evaluate diagnoses and determine appropriate services, including medical equipment, orthotics, prosthetics, and orthodontia. Manage case data and service authorizations.Community Engagement & Education: Maintain contact with families, providers, and community partners through phone, written communication and site visits across Ohio. Provide technical assistance and orientation to providers on CMH policies, procedures and billing. Plan and participate in educational workshops, seminars, and nursing care conferences. Resolve service delivery issues and respond to sensitive inquiries professionally and confidentially. Collaborate with nurse case managers and other stakeholders to ensure timely and effective case processing Administrative and Liaison Support: Maintain accurate and confidential client records in accordance with national, state and CMH guidelines.Perform administrative tasks such as answering phone, managing documents and operating office equipment.Serve as a liaison to government agencies, private sector partners and other state programs UNUSUAL WORKING CONDITIONS: May require travel Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsPosition Qualifications: Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria: 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs completion of undergraduate core program in nursing to include 1 course in community health nursing or public health nursing & 1 course in research methodologies or equivalent.1 course or 3 mos. exp. in operation of personal computer. Or Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria: 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs. 24 mos. exp. in nursing, which included 3 mos. trg. or 3 mos. exp, in community health or public health nursing & 3 mos. trg. or 3 mos. exp. in data collection & analysis.1 course or 3 mos. exp. in operation of personal computer. Or Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure. Additional Qualifications: Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:Graduate or advanced degree in nursing Experience in pediatric nursing and case management of children/ young adults with special health care needs Experience providing technical assistance/consultation services to a local health department or other provider of child /young adults health services (e.g., hospitals, pediatric clinics, physician's offices, other health care related professionals) Experience in public/community and/or home health nursing Experience reviewing and authorizing medical plans of treatment/requests for services (e.g., may include durable medical equipment/orthotics/prosthetics/orthodontic services/therapies) Certified Nurse Case Manager/ Discharge Planner or Certified Pediatric NurseExperience in analyzing health related data to prepare reports (e.g., quality assurance/technical reports, medical reports) Experience providing education or training to various groups (e.g., medical groups, nursing staff, parents, young adults) Experience with computer software (e.g., Microsoft Office: Word, PowerPoint) All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record Job Skills: NursingTechnical Skills: Health Administration, Medical Records, Nursing, Public Health, Public RelationsProfessional Skills: Analyzations, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written CommunicationsEducational Transcript Requirements: Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within five (5) working days of being requested will cause the applicant to be eliminated from further consideration. Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree.If you are using education or coursework to meet the minimum qualifications for this position, an official transcript must be attached prior to submitting your application. Supplemental InformationSupplemental Information:ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.Unless required by legislation, the selected candidate will begin at Pay Grade 13, Step 1 of the SEIU/1199 union Pay Range Schedule ($34.96 per hour), with an opportunity for pay increase after six months ($36.65 per hour) of satisfactory performance and then a yearly raise thereafter. APPLICATION PROCEDURES: All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.STATUS OF POSTED POSITION:You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.BACKGROUND CHECK NOTICE:The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.All final applicants tentatively selected for this class will be required to submit to urinalysis to test for illegal drug use prior to appointments. An applicant with a positive test shall not be offered employment.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Regional Nurse Consultant (RN) - Skilled Nursing | Dayton, OH Join a highly respected Senior Care organization offering a Regional Nurse Consultant role with real autonomy, strong support, and excellent work/life balance. You'll oversee 6 Skilled Nursing Facilities, all located in the Dayton market, allowing you to be home every night. Highlights: Oversee 6 SNF buildings (Dayton area) $124K-$144K salary + aggressive compensation package Excellent work/life balance with flexibility Strong corporate and facility-level support Clean, well-run buildings with a great local reputation Growth opportunity within the organization All travel and expenses reimbursed Requirements: Active Ohio RN license Prior Regional or multi-facility experience Previous DON experience in Skilled Nursing Strong clinical, leadership, and communication skills Willingness to travel locally Apply today to learn more about this standout regional opportunity. Chris Morley Senior Account Executive ************ *******************

Substitute/RN/LPN District: Tipp City Exempted Vilage Schools Tipp City Schools is seeking qualified substitute nurses to provide health services and care to students and staff in the absence of the regular school nurse. Duties may include administering medications, managing health plans, responding to emergencies, and supporting daily clinic operations. Minimum Qualifications: Valid Ohio RN or LPN license Current CPR certification School nursing experience preferred but not required Pass BCI/FBI background checks Orientation Opportunity: We will host a Substitute Orientation on August 7th for all new substitutes. More information will be shared as the date approaches. To Apply: Please submit your application through the Dayton Area School Employment Consortium at *******************************************

Job Description Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals, and interventions. Based on assessments and claims data creates a care plan for members to follow 70% Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the members health care needs, barriers to care and explore better outcomes for the member 20% Identify and link members with health plan benefits and community resources 5% Perform administrative work to maintain skills needed for job duties 5% 5% Experience: Required: 2 years LPN Nursing exp, preferred 3 + years experience. Regular and reliable attendance Familiar with community resources & services Strong organizational skills Works independently. Maintains professional relationships with the members we serve as well as colleagues. Communicates effectively and professionally verbally and in writing. Proficient with computer systems Knowledgeable in Microsoft Office Software Excellent customer service skills Has a dedicated home work space Position Summary: Looking for Columbus OH and immediate surrounding counties. The Care Manager Specialist is a member of the Care Team. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan. These members are usually stratified as low medium stratification, or those with Social Determents of Care needs. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the members health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess members needs as well as gaps in care, communicate with the members Primary Care Provider (PCP), maintain updated individualized care plans, and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately. Complete health screening questionnaires, assessments which may be market specific. Support reduction of population of unable to reach members by telephone and in -person visits. Ensure member has filled/received their medication(s) and has an understanding on how to take their ordered medications. Manage caseload of members with current stratification of monitoring, low and medium or those with high social determinants of care needs- frequency /contract guidelines Provides clinical assistance to determine appropriate services and supports due to members health needs (including but not limited to: Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports) Evaluation of health and social indicators Identifies and engages barriers to achieving optimal member health. Uses discretion to apply strategies to reduce member risk. Presents cases at case conferences for multidisciplinary focus to benefit overall member management. Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the members condition(s) and abilities to self-manage. Coordinates resources, assists with securing DME, and helps to ensure timely physician follow-up. Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. Updates the Care Plan for any change in condition or behavioral health status. Provide support to members in transitions of care Education: HS or equivalent, must be licensed LPN. What Days & Hours will the Person Work in this Position List Training Hours, if Different. M-F 8-5

Job Description NCA is in search of an experienced Field Nurse Case Manager based near the following locations: San Francisco, CA San Jose, CA Modesto, CA Los Angeles, CA Portland, OR Las Vegas, NV Phoenix, AZ This position will be responsible for regional case management services responsive to special needs and elder client care and quality of life challenges. This position requires collaboration with the primary family caregivers, attorneys, financial planners and trustees that are also serving the client. Requirements Bachelor of Science in Nursing (BSN) required, CCM or CRRN preferred Minimum of 5 years clinical Nursing experience - experience in field case management or workers' compensation case management, preferred Experience with third-party benefits - health insurance, Medicaid, Social Security, Developmental Disability services Excellent communication skills - written and verbal Highly motivated self-starter comfortable working in a virtual company/office, with solid time management and organization skills Proficient in using MacOS and a variety of related software applications (including MS Office) Strong ability to quickly learn and adapt to new technologies and tools in a Mac environment Proven ability to collaborate as necessary to accomplish goals and work through conflicts Ability to research and develop solutions to challenges presented by the client Excellent customer service skills Overnight travel required regionally 1-2 times per month and occasional nationwide travel Willingness to meet timely documentation requirements This is a salaried position with competitive pay, excellent benefits, and a flexible work from home schedule.

Job DescriptionSalary: $20.00-$25.00 Senior Care Case Manager Quality Moments is looking for a compassionate, reliable, and friendly individual to provide therapeutic activities and companionship to individuals in skilled nursing facilities. Do you have an inherent respect and compassion for elders? Do you believe all individuals should be treated with dignity and provided with support throughout aging? Are you energized and fulfilled by building meaningful relationships and enriching the lives of others? If this sounds like you, Quality Moments wants to hear from you. The Senior Care Case Manager is an excellent opportunity to enrich the lives of seniors through individualized activities related to social, emotional, and behavioral well-being. Quality Moments is looking for an individual whose desire to serve others aligns with our value of personal connection, keeping commitments, and putting people first in our lives. Qualifications and Responsibilities of Senior Care Case Manager Desire to improve quality of life for aging adults. Must have experience working with Alzheimer patients. High level of commitment, dependability, and interpersonal skills. Prior experience as an STNA, CNA, or in a nursing or long-term care setting is preferred. Prior experience in social work, counseling, human services, or a related field is preferred. Valid drivers license and reliable transportation with current automobile insurance meeting state minimum liability requirements. Previous EHR system use, and professional documentation experience are helpful.

* Starting pay is $29 / hour! * This is a full time position offering a 12 hour shift schedule, 7pm-7am! Every other weekend is required! The Wellness Nurse (LPN) will provide clinical monitoring and support for residents with Alzheimer's/Dementia. Ensures that all restorative, support and preventative measures are met in accordance with applicable state laws and regulations. Experience with Alzheimer's/Dementia or behavioral health conditions, and a willingness to work with the elderly population is essential for this role. Working at Artis Senior Living, you'll play an integral role on a dynamic team helping people living with dementia achieve the essential human needs of purpose, belonging and joy by building a bridge between their lifelong identity and present daily life - we call this act of service "Honoring Yesterday & Celebrating Today." We like to think that Artis associates are the most thoughtful people on the planet, so in return - they deserve to feel safe, supported, and inspired to grow. We truly look forward to you being part of the Artis family! We are proud to be a Great Place to Work Certified company. The Wellness Nurse (LPN) will: * Take an active role in resident assessments, development of service plans, and daily care. * Oversee and implement the self-administered medication management program for residents. * Administer medication and/or treatment to residents in accordance with physician orders. * Document and report care provided and resident observations including unusual or significant changes in physical, mental, or behavioral conditions. * Provide emotional support, physical comfort and ensure ongoing safety of residents. * Supervise Care Partners and Home Health Aides in providing resident care in accordance with State, Federal and Artis guidelines. * Ensure residents receive the highest quality of service in a caring and compassionate atmosphere which recognizes their individual needs and rights. * Assist in the marketing of the community by touring and participating in public relation events; establishing relationships with potential resident referral sources. * Assist with resident move-ins and relocations, help residents acclimate to their new surroundings and community personnel. * Performs other duties as required. Education Requirements: * Must possess current Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) designation as granted by State Board of Nursing. * Fulfill and maintain continuing education credits as required by state. * Experience in rehabilitative or geriatric nursing is preferred.

Here are the job details for your review: Job Title: Nurse Case Manager II Job Location: Looking in Toledo region. Lucas, Fulton, Ottawa and Wood Counties. Duration: 3+ Months Contract (Potential for extension) Pay Rate: $39.39/HR on W2 Shift: M-F 8-5 EST Position will require travel to members' homes up to 50-75% travel. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Qualification Additional Details Duties: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Experience: 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. Healthcare and/or managed care industry experience. Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Proficient in MS Office Suite (TEAMS, Word, Excel, Outlook) Effective communication skills, both verbal and written. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Typical office working environment with productivity and quality expectations. Must show that they are able to get their work done in an efficient manner. Their work will be audited. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license Education: RN with current unrestricted state licensure from Ohio. Case Management Certification CCM preferred

Substitute Certified Positions/Substitute Nurse Substitute Nurse positions are available for the Mansfield City Schools District. Applicants for this position must have valid nursing licensure for the State of Ohio. All substitutes must complete pre-employment requirements that include fingerprint checks through the Ohio Bureau of Criminal Identification and Investigation and the Federal Bureau of Investigation in addition to other pre-employment screenings. All screenings are completed at the potential applicant's expense.

Are you an experienced MDS nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Heath may be just what you're looking for! Benefits: Comprehensive health insurance - medical, dental and vision. 401K with matching funds. DailyPay, a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications: Registered Nurse (RN) or Licensed Practical Nurse (LPN). AANC certification a plus. RAC-CT. Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse or willingness to learn. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. #IND123 By applying, you consent to your information being transmitted by College Recruiter to the Employer, as data controller, through the Employer's data processor SonicJobs. See Ciena Healthcare Management Privacy Policy at privacy_policy/ and SonicJobs Privacy Policy at us/privacy-policy and Terms of Use at us/terms-conditions

Behavioral Health Unit Full Time 36 Hours/week Days 7a-730p Onsite The Staff Nurse provides nursing care requiring specialized knowledge judgment and skill derived from the principles of biological, physical, behavioral, social and nursing sciences. Responsibilities: 1. Assesses, plans, implements, evaluates and directs nursing care with a focus on family centered care for individuals or groups of patients within the assigned scope of practice. 2. Demonstrates the knowledge and skills necessary to provide care for the physical, psychosocial, educational, and safety needs of the patients served regardless of age and developmental status is required. 3. Performs leadership and professional duties. 4. Performs patient-centered care duties. 5. Performs quality improvement and safety duties. 6. Participates in the development education for staff members for clinically related issues. May be responsible for precepting new employees and act as a mentor to the clinical staff. 7. Performs evidence-based practice duties. 8. Supports the provider staff and actively promotes collaboration for efficient operation and quality care, and legendary customer service for pediatric patients using a team approach. 9. Performs systems-based practice duties. 10. Performs informatics and technology duties. 11. Staff may be temporarily assigned to an area throughout the Akron Children's Hospital enterprise, based on patient needs requiring similar knowledge and skill. 12. Other duties as required. Other information: Technical Expertise 1. Demonstrated ability to provide leadership, guidance and motivation to other staff members with emphasis on working as a collaborative team to provide quality service to patients and their families. 2. Strong communication skills, both verbal and written are required. 3. Excellent customer service and interpersonal communication skills are required. 4. Strong organizational skills are required. 5. Ability to work well under pressure to prioritize and complete required tasks and responsibilities in a timely and accurate manner. 6. Experience working with various levels within an organization is required. 7. Experience in healthcare is preferred. 8. Experience working in Microsoft Office (Outlook, Excel, Word) or similar software is required. 9. Experience working an electronic medical record system (i.e. EPIC) or similar software is preferred. Education and Experience 1. Education: Bachelor of Science in Nursing (BSN) is required or must be obtained within 5 years from date of hire. 2. Current certification in Basic Life Support training from the American Heart Association is required. Additional certifications may be required based on the assigned department or unit. 3. A valid, active license to practice as a Registered Nurse (RN) in the state of Ohio is required. This must be a Multistate License (MSL). An MSL is required for departments that provide telenursing services or provide care to patients outside the state of Ohio. 4. Years of relevant experience: Minimum of one (1) year of experience is preferred. 5. Years of experience supervising: None Full Time FTE: 0.900000 Status: Onsite

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: Part Time Casual RN in the MedSurg unit at Van Wert Hospital. Provides general nursing care to patients and families throughout the continuum of care in diverse, acute health care settings. (Department has scheduled staff to operate 24/7/365). The RN accountable for the practice of nursing as defined by the Ohio Board of Nursing. The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive personnel (UAPs) using the criteria written in the Ohio Nurse Practice Act. According to department policies and nursing care standards, provides professional nursing care services to patients. Responsible for assessing, planning, implementing, and evaluating nursing care provided to assigned patients. Responsibilities And Duties: Assessment/Diagnosis - Performs initial, ongoing, and functional health status assessment as applicable to the population and or individual (30%). Outcomes Identification/Planning - Based on nursing diagnoses and collaborative problems, documents planned nursing interventions to achieve outcomes appropriate to patient needs (30%). Implementation/Evaluation - Evaluates and documents response to nursing interventions and achievement of outcomes at appropriately determined intervals; as part of a multidisciplinary team, revises plan of care based on evaluative data (20%). Leadership - Actively participates in process improvement activities to achieve targeted measures of clinical quality, customer satisfaction, and financial performance (10%). Operations (10%). Minimum Qualifications: Associate's Degree: NursingBLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing Additional Job Description: MINIMUM QUALIFICATIONS Current Registered Nurse license from the State of Ohio and/or current Registered Nurse license in good standing with a multi-state compact state. BLS certification BSN required at 5 years of employment Work Shift: Variable Scheduled Weekly Hours : As Needed Department Med Surg Unit 1 Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Why You Should Work For Us: 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! This is a utilization review position. Nurses will be responsible for collaborating with healthcare providers and members to promote quality member outcomes to optimize member benefits and to promote effective use of resources. Essentially they will be reviewing patient records and treatment profiles to ensure proper and cost effective treatment, member satisfaction, and quality results. They will be doing both inpatient and outpatient UM. Qualifications Job Description: This is a utilization review position. Nurses will be responsible for collaborating with healthcare providers and members to promote quality member outcomes to optimize member benefits and to promote effective use of resources. Essentially they will be reviewing patient records and treatment profiles to ensure proper and cost effective treatment, member satisfaction, and quality results. They will be doing both inpatient and outpatient UM. Additional Information Hours for this Position: M-F: 8am-4:30pm Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment Additional Information: 6-12 month long term contract Interested in being considered? If you are interested in applying to this position, please click the Green I'm Interested Button to email your resume.