- HUB International (Columbus, OH)
- **POSITION SUMMARY:** _The Director , Carrier Strategies is responsible for developing and executing a strategic plan to maximize revenue growth through carrier ... pre-qualify prospects, ensuring alignment with the region's new business strategy. Review all new business submissions to validate completeness, accuracy of… more
- Select Medical (Cleveland, OH)
- …documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control ... **Overview** **Cleveland Clinic Rehabilitation Hospital - Fairhill** ** Director of Quality Management** **(DQM)** **Opening in October, the Cleveland Clinic… more
- Highmark Health (Columbus, OH)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Travelers Insurance Company (Columbus, OH)
- …which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical ... guidelines to establish medical review policies. Works in close collaboration with the Claim...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- Molina Healthcare (Dayton, OH)
- …Reforecast according to Corporate guidelines. + Collaborate with Actuarial staff to review IBNR estimates and rate adequacy studies. + Analyze results to identify ... operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process regarding estimated… more
- Molina Healthcare (Dayton, OH)
- …guidelines + Coordinate the Market month-end close with Accounting staff; review all non-IBNR reserves for appropriateness monthly + Work collaboratively with ... impacting IBNR, including bed days and admits per 1,000, prescription drug utilization , billed dollars of inventory, and other measurable factors that may be… more
- OhioHealth (Columbus, OH)
- …in accordance to budget Prepare preliminary capital and human resources budgets for review and approval Assure timely capture and input of all billing information ... and approve maintenance agreements and service contracts in conjunction with the director Assist the director in managing contractual agreements Provide on-site… more
- ChenMed (Columbus, OH)
- …and explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... to attain partnership. + Assists the Associate Center Clinical Director and/or Market Clinical Director in the...Associate Center Clinical Director and/or Market Clinical Director in the selection, training, onboarding, and coaching of… more
- OhioHealth (Marion, OH)
- …the provision of quality health care to patients. Under the direction of the Director or the Assistant Director of Nursing, proactively coordinates patient care ... the ordering, receiving and storage of supplies/equipment. 4. Write, review and update policies and procedures on a regular...in the development of departmental budget; monitor and report utilization of personnel and supplies. 14. Plan for future… more
- Stark County Board of Developmental Disabilities (Canton, OH)
- …selection process; + Prepares data and reports as directed by the SSA Director ; + Verifies through supervision and review SSA dashboard, etc., monitoring ... and timeframes meet all Medicaid Waiver requirements; + Collaborates with Assistant Director (s) and Waiting List Review Committee to assure requests for… more