• Pharmacy Coordinator

    Highmark Health (Columbus, OH)
    …Wholecare's pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with ... address medication-related issues, promote adherence, and ensure appropriate medication utilization . **ESSENTIAL RESPONSIBILITIES** + Communicate effectively with physicians and… more
    Highmark Health (09/19/25)
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  • Case Manager-Sbhi

    Premier Health (Eaton, OH)
    Case Manager FACILITY: SAMARITAN BEHAVIORAL HEALTH Case Manager functions as a member of a team to assist in the planning, development, and delivery of ... for administration and reporting of outcome measures and documentation of utilization management of clinical care. . Demonstrate knowledge of other regulatory… more
    Premier Health (09/04/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Columbus, OH)
    …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year of ... **Substitutions** + 6 years experience in pharmacy or managed health care setting in lieu of Bachelor degree **Preferred**...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (08/26/25)
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  • Manager Software Engineering - AI Platforms…

    Highmark Health (Columbus, OH)
    **Company :** Highmark Health **Job Description :** Entirely Remote Work From Anywhere Role! We are seeking an experienced Software Engineering Manager to lead our ... have budgetary responsibility and authority. + Understand budget and resource utilization across the product teams. Escalate any issues regarding product delivery… more
    Highmark Health (08/08/25)
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  • Senior Architect - Cloud

    Highmark Health (Columbus, OH)
    **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
    Highmark Health (07/22/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Cleveland, OH)
    … utilization management, care transitions, long-term services and supports (LTSS), behavioral health , and other clinical programs, and collaborates with ... every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance. *...at least 2 years of managed care experienced in utilization management * Registered Nurse (RN) ONLY if required… more
    Molina Healthcare (09/26/25)
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  • Healthcare Services Operations Support Auditor

    Molina Healthcare (Columbus, OH)
    …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management, care management, behavioral health ... to subsequently resolve/correct. Required Qualifications * At least 2 years health care experience, preferably in utilization management, care management,… more
    Molina Healthcare (09/28/25)
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  • Care Manager

    AmeriHealth Caritas (Dublin, OH)
    …determinants of health for members with acute, chronic, medically complex, and/or behavioral health conditions and other health needs. Serves as the ... Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams. + Maintain timely, complete, and accurate… more
    AmeriHealth Caritas (10/02/25)
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  • Care Review Clinician, PA (RN)

    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. ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred… more
    Molina Healthcare (09/05/25)
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  • Clinical UM Nurse 2

    CenterWell (Columbus, OH)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
    CenterWell (09/26/25)
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