- Molina Healthcare (Akron, OH)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Dayton, OH)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… 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 ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Humana (Columbus, OH)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market,… more
- Elevance Health (Lima, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Medical Director -Long Term Support and Services- MyCare OHIO**...responsible for developing and implementing programs to improve quality, utilization trends, and member outcomes. May provide clinical consultation… 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 ... in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- Molina Healthcare (Cleveland, OH)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical ... Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health… more
- Molina Healthcare (Columbus, OH)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… 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 ... in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- Molina Healthcare (OH)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more