• Medical Management Specialist I

    Elevance Health (Columbus, OH)
    …clinical information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
    Elevance Health (09/24/25)
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  • Pharmacy Branch Manager

    KPH Healthcare Services, Inc. (Maumee, OH)
    …activities, educational programs, and departmental/branch meetings. + Drives the Primary Case Management Model (PCMM) in daily interactions through the ... to patients, nurses and physicians as required regarding the contents, utilization , therapeutic actions, possible adverse reactions, or interactions of drugs. +… more
    KPH Healthcare Services, Inc. (09/03/25)
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  • Disease Management Nurse - Remote

    Sharecare (Columbus, OH)
    …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... disease management program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager...during the training period will be evaluated on a case by case basis and must be… more
    Sharecare (09/13/25)
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  • Software Asset Management Specialist…

    CDM Smith (Toledo, OH)
    …project demands. **Preferred Qualifications:** * SAM, CSAM (Certified Software Asset Manager ), or SAMS (Software Asset Management Specialist) certifications ... Description:** CDM Smith is seeking a Senior IT Asset Management Specialist to lead and manage all aspects of...and improvements. * Provide insights that matter: Report on utilization , explain budget variances, and present forecasts to key… more
    CDM Smith (09/20/25)
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  • Medical Management Clinician

    Elevance Health (Independence, OH)
    …health, long term services and supports, and psychosocial needs._ **Medical Management Clinician** **Location:** This role enables associates to work virtually ... hours may be necessary based on company needs. The **Medical Management Clinician** responsible for ensuring appropriate, consistent administration of plan benefits… more
    Elevance Health (09/10/25)
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  • LTSS Transition Concierge Coordinator

    Elevance Health (Columbus, OH)
    **LTSS Concierge Coordinator ( Case Manager )** **Hiring statewide across Ohio** **This position is primarily virtual but may require you to work in the field ... visits, as needed, to accommodate business need. + Submits utilization /authorization requests to utilization management ...health care related field preferred. + Strong preference for case management experience with older adults or… more
    Elevance Health (09/27/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Cleveland, OH)
    …active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), ... team supporting one or more of the following functions: care management , utilization management , care transitions, long-term services and supports (LTSS),… more
    Molina Healthcare (09/26/25)
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  • Lead Information Security Engineer

    Lumen (Columbus, OH)
    …false notifications + Automation of work functions and capabilities + Assist with management of vendors for meeting Lumen needs and improving capabilities + Develop ... show value and improvement for technologies and processes. + Create and analyze utilization statistics of systems to identify causes for system degradations as well… more
    Lumen (09/30/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Cleveland, OH)
    …Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in ... Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
    Molina Healthcare (09/26/25)
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  • Anti-Human Trafficking Crisis Response Coordinator

    The Salvation Army (Cincinnati, OH)
    …response and emergency supervision, crisis intervention, intake and short-term case management . Responsibilities DUTIES:* Support provision of emergency ... Army.o Providing rotating 24 hour emergency response and comprehensive initial case management .o Assessment immediate needs and conduct intakes.o Coordination… more
    The Salvation Army (09/28/25)
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