• Medical Management Specialist I

    Elevance Health (Cincinnati, 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 (07/19/25)
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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. (06/05/25)
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  • Medical Director, MSK Surgery

    Evolent (Columbus, OH)
    …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
    Evolent (05/20/25)
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  • Registered Nurse (RN) - Admissions Coordinator…

    Bon Secours Mercy Health (Lorain, OH)
    …has smooth transition to acute rehab unit. Maintains expertise in clinical field, utilization review and case management ; communicates to insurance ... program. The Admissions Coordinator RN cross trains to cover case management as needed, which includes initiating...and coordination. Leads rehab team meetings when covering for case manager to discuss appropriateness of program… more
    Bon Secours Mercy Health (05/19/25)
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  • Registered Nurse (RN) - Admissions Coordinator…

    Bon Secours Mercy Health (Lorain, OH)
    …has smooth transition to acute rehab unit. Maintains expertise in clinical field, utilization review and case management ; communicates to insurance ... program. The Admissions Coordinator RN cross trains to cover case management as needed, which includes initiating...and coordination. Leads rehab team meetings when covering for case manager to discuss appropriateness of program… more
    Bon Secours Mercy Health (07/22/25)
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  • Licensed Social Worker (LSW) - Fairfield Hospital

    Bon Secours Mercy Health (Fairfield, OH)
    …(required, preferred in VA)Accredited Case Manager Certification (ACM) from American Case Management Association or Certified Case Manager (CCM) ... by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership.*Stays… more
    Bon Secours Mercy Health (05/01/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (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 (07/20/25)
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  • Surgical Onsite Specialist

    Medtronic (Dayton, OH)
    …the Life** The Surgical Onsite Specialist (SOS) is responsible for providing case support and customer support, training and education, and solution implementation ... Surgical Centers of Therapy (COTs). This role ensures seamless product utilization by assisting with on-site procedures, addressing customer inquiries, performing… more
    Medtronic (07/09/25)
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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 (06/29/25)
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  • Medical Director - Commercial

    Elevance Health (Cincinnati, OH)
    …to work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
    Elevance Health (07/25/25)
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