• Part-Time Weekend Medical Director (Remote)

    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
    Highmark Health (09/11/25)
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  • Manager, Healthcare Services

    Molina Healthcare (OH)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina… more
    Molina Healthcare (09/27/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (Akron, OH)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge… more
    Molina Healthcare (09/18/25)
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  • Medical Director-Dermatology Appeals

    Elevance Health (Mason, OH)
    …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... is responsible for the review of appeals for physical health medical services, to ensure the appropriate and most...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
    Elevance Health (10/01/25)
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  • Community Relations Consultant - MyCare Ohio…

    Elevance Health (Dayton, 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
    Elevance Health (09/24/25)
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  • Medical Management Clinician

    Elevance Health (Independence, OH)
    …culturally competent, person_ _‐_ _centered coordination for all members that addresses physical health , behavioral health , long term services and supports, ... a minimum of 4 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted...or RN license and/or certification to practice as a health professional within the scope of licensure in applicable… more
    Elevance Health (09/10/25)
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  • Medical Director-PSCCR

    Elevance Health (Mason, OH)
    …The **Medical Director-PSCCR** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. + Identifies and...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
    Elevance Health (09/10/25)
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  • Clinical Team Leader - Mental Health Unit…

    Dayton Children's Hospital (Dayton, OH)
    Facility:Mathile Center for Mental Health and WellnessDepartment: Behavioral HealthSchedule:Full timeHours:36Job Details:The Clinical Team Leader (CTL) identifies ... to safety, may serve as a de-escalation trainer, promotes utilization of Hospital Acquired Condition Prevention tools, and remains...for the selection or discharge of employees of the health care facility. Department Specific Job Details: + full… more
    Dayton Children's Hospital (10/03/25)
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  • Therapist LISW/PCC

    Premier Health (Dayton, OH)
    Facility: Samaritan Behavioral Health , Inc The therapist plans and delivers outcome-effective clinical, case coordination, intervention, prevention, and/or ... consultation mental health services to pediatrics and their parents, and the...administration and reporting of outcome measures and documentation of utilization management of clinical care. . Demonstrate knowledge of… more
    Premier Health (10/02/25)
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  • Change Execution Consultant

    Highmark Health (Columbus, OH)
    **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (09/19/25)
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