- Bon Secours Mercy Health (Lima, OH)
- …Primary Function** In the capacity of a Registered Nurse, the Ambulatory Care Manager will provide clinical care management services to identified eligible ... enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management. Develop and implement care plans to maximize… more
- Select Medical (Cleveland, OH)
- …preferred + Experience in ICD-10 coding preferred + Experience as a Case Manager in rehabilitation preferred **Additional Data** _Equal Opportunity Employer, ... Name:** Cleveland Clinic Rehabilitation Hospital - Fairhill **Position:** PPS Manager **Location:** Cleveland, OH **Hours:** 40 hours/week **Opening in October,… more
- Molina Healthcare (OH)
- …experience. **Preferred License, Certification, Association** Any of the following: Certified Case Manager (CCM), Certified Professional in Healthcare Management ... including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management. + Minimum 2… more
- KPH Healthcare Services, Inc. (Maumee, OH)
- …in training and orientation of new employees. + Provides technical and clinical information and communicates results of monitoring activities to patients, nurses and ... physicians as required regarding the contents, utilization , therapeutic actions, possible adverse reactions, or interactions of drugs. + Initiates, reviews, and… more
- Bon Secours Mercy Health (Lorain, OH)
- …ensure that patient has smooth transition to acute rehab unit. Maintains expertise in clinical field, utilization review and case management; communicates to ... include discharge planning and coordination. Leads rehab team meetings when covering for case manager to discuss appropriateness of program and progress of… more
- Evolent (Columbus, OH)
- …and staff whenever a physician`s input is needed or required. Responsible for clinical audits for quality and education regarding the results and monitoring for ... Responsible for coordinating education and findings with matrixed Physician Business Manager . + Provides medical direction to the support services review process.… more
- Elevance Health (Cincinnati, OH)
- …work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Bon Secours Mercy Health (Fairfield, OH)
- …as a Social Worker in state of practice (required, preferred in VA)Accredited Case Manager Certification (ACM) from American Case Management Association ... Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. + The Social Worker Care...Case Manager (CCM) from Commission for Case Manager Certification (preferred)EducationBachelor of Social Work… more
- Molina Healthcare (Columbus, OH)
- …Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional ... for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and… more
- Prime Therapeutics (Columbus, OH)
- …for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a higher ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates… more