- Elevance Health (Columbus, OH)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Molina Healthcare (Dayton, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- OhioHealth (Columbus, OH)
- …- in our careers and in our communities. **Job Description Summary:** The Case Manager extender works collaboratively with all interdisciplinary staff internal ... room and bed charges and performing charge reconciliation. The case manager extender is well organized, highly...beyond level of authority to care coordination/UM team and Manager /Director of UM team for review and… more
- CVS Health (Columbus, OH)
- …is required. **Preferred Qualifications** + Crisis intervention skills preferred. + Managed care/ utilization review experience preferred. + Case management ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. **Position… more
- 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 ... clients and uses that knowledge to coordinate services and advocate for identified clients. Case Manager acts as a resource consultant to other team members and… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- National Youth Advocate Program (Columbus, OH)
- ** Utilization Manager /Continuous Quality Improvement Manager - Columbus** **Compensation:** $82,000 - $85,000 **Position Summary** The Utilization ... 401K Matching flexible hours, mileage reimbursement, phone allowance **Responsibilities** The Utilization Manager /Continuous Quality Improvement Manager will… more
- Molina Healthcare (Akron, OH)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified… more
- Molina Healthcare (OH)
- …experience. **Preferred License, Certification, Association** Any of the following: Certified Case Manager (CCM), Certified Professional in Healthcare Management ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Elevance Health (Columbus, OH)
- **JR167272 Manager Behavioral Health Services** Responsible for overseeing Behavioral Health Utilization Management (BH UM), this position supports the Medicaid ... assist with implementation of cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. + Hires, trains, coaches,… more
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