- Humana (Columbus, OH)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient… more
- Evolent (Columbus, OH)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Columbus, OH)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals .… more
- Evolent (Columbus, OH)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients' lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Humana (Columbus, OH)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient… more
- Molina Healthcare (Cincinnati, OH)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more
- Elevance Health (Mason, OH)
- …or medical arena. + Lead, develop, direct and implement clinical and non- clinical activities that impact health care quality cost and outcomes. + Identify ... with attending physicians or other ordering providers. + Discuss review determination, provide guidance for clinical operational...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Elevance Health (Mason, OH)
- …as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company to ... May chair company committees. + Interprets medical policies and clinical guidelines. + May develop and propose new medical...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Evolent (Columbus, OH)
- …engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited appeals ,** ensuring compliance with UM ... We Offer:** + A unique opportunity to **impact patient care beyond direct clinical practice.** + A...+ **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary… more
- ProMedica Health System (Toledo, OH)
- …of Experience: Minimum of 2 years clinical experience in a patient care setting. Previous experience with utilization review , marketing, care ... and healthcare providers effectively and diplomatically. Years of Experience: 3-5 years clinical experience in a patient care setting. License: As indicated… more