• Medical Director - Commercial

    Elevance Health (Independence, OH)
    …The **Medical Director** will be part of the Central Region team responsible for utilization review case management and appeals for local Commercial business ... 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 (09/24/25)
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  • Regional Team Leader, Specifications

    CDM Smith (Columbus, OH)
    …our Specifications Group. We're looking for candidates with experience as a Senior Manager and Senior Specification Writer. At CDM Smith, we are invested in your ... of your team. - Coordinating workload within your Technical Services group and utilization goals for the individuals on your team. - Coordinating with your TDM… more
    CDM Smith (08/01/25)
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  • LTSS Service Coordinator - Clinician (LSW, LCSW,…

    Elevance Health (Norwood, OH)
    **LTSS Service Coordinator - Clinician ( Case Manager )** **Hiring statewide across Ohio** **Location** : This field-based role enables associates to primarily ... state(s) required. **Preferred Skills, Capabilities and Experiences:** + Strong preference for case management experience with older adults or individuals with… more
    Elevance Health (09/12/25)
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  • Medical Director- Long Term Support Service (Ltss)

    Elevance Health (Wright Patterson AFB, OH)
    …a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written, ... 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 (09/26/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Columbus, OH)
    …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...appeals program. + Participates in meetings and consults with management on regular basis to discuss member interaction and… more
    Prime Therapeutics (09/04/25)
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  • Caseworker/Special Services Coordinator

    The Salvation Army (Youngstown, OH)
    …assist the Mahoning County Area Services Coordinator, Operations Director and Program Manager with social service programs, activities and assistance as requested. + ... and assistance. + Work with Operations Director and Program Manager to request volunteers as needed + Assist with...sources + Assist in the identification, recruitment, training and utilization of volunteers for both local and seasonal social… more
    The Salvation Army (09/18/25)
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  • LVN Delegation Oversight Nurse Remote

    Molina Healthcare (Cincinnati, OH)
    …Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified ... reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint… more
    Molina Healthcare (09/20/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Akron, OH)
    …Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management , Certified Professional in ... of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.… more
    Molina Healthcare (09/06/25)
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  • Senior Information Security Engineer- SIEM

    Lumen (Columbus, OH)
    …part of planning, engineering and overseeing our SIEM (Security Information Event Manager ) environment which is undergoing significant change. Lumen is in the ... Help maintain and keep operational the legacy Splunk environment. + Help build management constructs needed for maximum efficiency and capability for a new SIEM… more
    Lumen (09/30/25)
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  • Associate Medical Director- Sleep Medicine

    Elevance Health (Mason, OH)
    **Clinical Operations Associate Medical Director** **Carelon Medical Benefits Management ** **Radiology Benefit** ** Management / Utilization ** **Review** ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
    Elevance Health (09/04/25)
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