- Elevance Health (Cincinnati, OH)
- …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England (CT, ME,… more
- Elevance Health (Canton, OH)
- …informed, culturally competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term services and ... evaluation, coordination and management of member's needs, including physical health , behavioral health , social services... care team, to ensure cost effective and efficient utilization of health benefits. + Decision making… more
- Highmark Health (Columbus, OH)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical ... Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS,… more
- Highmark Health (Columbus, OH)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Molina Healthcare (OH)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... disorders. * Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical… more
- Highmark Health (Columbus, OH)
- …agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees. ... designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret… more
- Army National Guard Units (Columbus, OH)
- …Recognizes and takes action to correct situations posing a threat to the health or safety of subordinates. Applies EEO principles and requirements to all personnel ... position descriptions to ensure accuracy, and the most effective utilization of personnel resources. Explains classification determinations to subordinate employees.… more
- Elevance Health (Mason, OH)
- …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... **National Government Services** is a proud member of Elevance Health 's family of brands. We administer government contracts for...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Columbus, OH)
- …informed, culturally competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term services and ... and other community organizations in educational and outreach activities. + Tracks utilization of company contributions. + Serves as a representative at company… more
- Somatus (Columbus, OH)
- …Records) systems + Minimum three (3) years working with patients with chronic and/or behavioral health needs Ability to be credentialed in local hospital system. ... **Showing Up for You** We offer more than 25 Health , Growth, and Wealth Work Perks to help teammates...plans to address areas to reduce admissions and cost utilization + Other duties as assigned _Please note this… more