- Highmark Health (Columbus, OH)
- …internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy and ... Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required....position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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
- 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
- Bon Secours Mercy Health (Lorain, OH)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... directs patient teaching activities and coordinates the care provided by health team members. **Essential Job Functions** In collaboration with the interdisciplinary… more
- Humana (Columbus, OH)
- …community and help us put health first** The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' ... appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require… more
- Bon Secours Mercy Health (Springfield, OH)
- …Science or Arts, or other related field (required) Masters Degree in Behavioral Health or related field (preferred) **Minimum Qualifications** **Minimum Years ... At Bon Secours Mercy Health , we are dedicated to continually improving ...+ Provide accurate and timely documentation of services + Utilization review of assigned clients + Provide education to… more
- 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. Education An Associate Degree in Nursing… more
- Highmark Health (Columbus, OH)
- …application designs to ensure optimal technology selection, efficient resource utilization , and seamless system integration. + Ensure system architecture adheres ... and FDI SOAP. + **Performance Optimization:** Proven ability in performance tuning, health checks, and cost tracking. + **Operational Excellence:** Strong skills in… more
- Sevita (Oakwood Village, OH)
- …program including delivery of supports, implementation of person-centered plans, health care, advocacy, customer engagement, regulatory compliance and when ... submits initial incident reports to the Program Director. 8. Billing and Utilization : Compiles or accumulates census or attendance information; reviews data and… more
- CenterWell (Columbus, OH)
- …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 ... part of our caring community and help us put health first** The Medical Director, Primary Care relies on...Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization … more