Top 5 Clinical nurse auditor Jobs in Columbus

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
- $40.40 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
11d
Clinical Quality Auditor Contingent/IRP
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
5d
Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)
Molina Healthcare —Columbus, OH
- $54,922 - $107,099 a year
- Full-time
- Remote
- RN License
- Writing skills
- Analysis skills
- Health insurance
Compliance Educator
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Nursing
- RN License
- Public speaking
Full-Time Home Health OASIS Auditor (HCS-O or COS-C )
National Church Residences —Dublin, OH
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
11d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
11d

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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
11d
Clinical Quality Auditor Contingent/IRP
The Ohio State University Wexner Medical Center —Columbus, OH
The Clinical Quality Auditor will assist to identify and facilitate opportunities for improvement in the delivery of patient care related to clinical care,…
5d

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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

State of Ohio - Medicaid -
Columbus, OH

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Job Details

Full-time
$40.40 an hour
11 days ago

Benefits

Paid holidays
Health insurance
Dental insurance
Paid time off
Vision insurance
Loan forgiveness
Life insurance

Qualifications

RN License
Customer inquiry handling

Full Job Description

What You Will Do At ODM:

Office: Legal Counsel

Bureau: Program Integrity

Classification: Medicaid Health Systems Administrator 1 RN (PN: 20092018)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS). SURS is charged with helping the agency review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate payments to providers. As a Clinical Review Nurse Supervisor your responsibilities will include:

Helping to manage an over $ 7million/ year hospital utilization contract
Reviewing necessary medical record reviews and making a determination on hospital appeals.
Supervising and training RNs, Auditors, and Analysts in identifying fraud, waste, and abuse in the Medicaid program.
Participating/leading meetings with external stakeholders including law enforcement
Developing and implementing changes to processes and procedures as needed in a team environment
Evaluating provider clinical compliance with state and federal Program Integrity rules
Evaluating provider medical documentation and billing practices for fraud, waste and abuse
Recovering overpayments for medically unnecessary services via administrative procedures and/or referrals to health oversight agencies
Responding to provider clinical reconsideration (appeal) requests
Consulting on clinical matters with ODM policy units and other state agencies
Coordinating clinical Program Integrity efforts with ODM contractors and managed care plans
Presenting findings from clinical reviews of provider non-compliance
Responding to inquiries from the public, consumers, providers, and other agencies

Why Work for the State of Ohio

At 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.

Qualifications

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis); Current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code;

Or 12 months experience as Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure.

Note: education & experience is to be commensurate with approved position description on file.

Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Technical Skills: Nursing

Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication

Supplemental Information

Supplemental Information:

Compensation is as listed on the posting unless required by legislation or union contract.

Must poses Current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code

This positions is overtime exempt.

Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.

Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application.

ADA Statement

Ohio 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 Workplace

The 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.

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Refine Your Search

clinical nurse auditor jobs in columbus

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

Clinical Quality Auditor Contingent/IRP

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Compliance Educator

Full-Time Home Health OASIS Auditor (HCS-O or COS-C )

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