- Red River (Columbus, OH)
- **Position Summary:** The Manager, Residency Services reports to Director of Professional Services. Responsibilities include: Identifying new Residency Services ... cost center. + Manage field operatives working at a full time, or 100% utilization less time off. + Leverage SKU-based residency services to OEM equipment purchases… more
- Battelle Memorial Institute (Columbus, OH)
- …existing solutions. Less hands-on work, more providing guidance. Serves as study director . Conducts quality control review , data reporting, workflow assessments ... or client meetings. + May participate in scientific conferences, peer review panels, and increase company visibility through publications. + Oversee, mentors… more
- Cognizant (Columbus, OH)
- …. Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Elevance Health (Cincinnati, OH)
- …members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance ... Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Centene Corporation (Columbus, OH)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Evolent (Columbus, OH)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Humana (Columbus, OH)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Humana (Columbus, OH)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Columbus, OH)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Columbus, OH)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
