• Director, Appeals & Grievances (Medicare)

    Molina Healthcare (Cleveland, OH)
    …leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... complaints, appeals , and claim disputes, and communicating resolution to members,...Coordinates with Customer/Member services, Provider Services, Sales, Enrollment, UM, Case Management, Claims, and other departments within Molina Medicare… more
    Molina Healthcare (07/20/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Cleveland, OH)
    …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... request authorization. Strongly prefer candidates with a background in appeals and grievances. Excellent computer multi-tasking skills and good productivity… more
    Molina Healthcare (08/02/25)
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  • LTSS Service Coordinator ( Case…

    Elevance Health (Mason, OH)
    **LTSS Service Coordinator ( Case Manager )** **Hiring statewide across Ohio** **Location** : This field-based role enables associates to primarily operate in the ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
    Elevance Health (07/15/25)
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  • Bilingual Case Manager

    Cardinal Health (Columbus, OH)
    …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
    Cardinal Health (07/18/25)
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  • Field Reimbursement Manager

    Adecco US, Inc. (Columbus, OH)
    Adecco is assisting a local client recruiting for **Field Reimbursement Manager ** opportunities in **Remote - Work From Home (NY-based territory)** . This is an ... and empowers healthcare providers with critical reimbursement education. If **Field Reimbursement Manager ** sounds like something you would be interested in, and you… more
    Adecco US, Inc. (07/08/25)
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  • Product Manager Power Components

    Ralliant (Columbus, OH)
    **Job Title:** Product Manager **Location:** Remote, USA **Job Summary:** As a key contributor within Hengstler-Dynapar, the **Product Manager ** will guide the ... aligns with the company's business objectives while collaborating cross-functionally. The Product Manager will work closely with all functions within our company to… more
    Ralliant (07/23/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (Columbus, OH)
    …The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will ... expert. + Ensures Molina is compliant with the coverage determination and appeals process. + Contributes to projects aimed at improving Star ratings, HEDIS,… more
    Molina Healthcare (07/27/25)
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  • Medical Director, MSK Surgery

    Evolent (Columbus, OH)
    …Responsible for coordinating education and findings with matrixed Physician Business Manager . + Provides medical direction to the support services review process. ... Responsible for the quality of utilization review determinations, including appeals . + Provides input into audit processes including development of questions. +… more
    Evolent (05/20/25)
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  • Infusion Referral Nurse- REMOTE

    Prime Therapeutics (Columbus, OH)
    …an office or home setting for drug services. + Will actively maintain a required case load and the activities to reach overall goals of switching site of service ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...is valued with the program. + Maintains an active case load and accurate case records, adhering… more
    Prime Therapeutics (07/24/25)
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  • Medical Director - Commercial

    Elevance Health (Cincinnati, OH)
    …time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England (CT, ME, and NH) ... and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
    Elevance Health (07/25/25)
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