• Utilization Review Nurse - Pool

    Dayton Children's Hospital (Dayton, OH)
    …Utilization Review TeamSchedule:Part timeHours:8Job Details:Under the supervision of the Manager of Utilization Management , the Utilization ... information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource...a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan… more
    Dayton Children's Hospital (09/17/25)
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  • RN, Manager , Utilization…

    Humana (Columbus, OH)
    **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works...of Michigan. + Previous experience in utilization management and/or utilization review . +… more
    Humana (09/28/25)
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  • Utilization Management Medical…

    Elevance Health (Columbus, OH)
    …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... ** Utilization Management Medical Director- NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (09/26/25)
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  • Pharmacist, Utilization Management…

    Molina Healthcare (Dayton, OH)
    … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
    Molina Healthcare (09/25/25)
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  • Project Manager - Program Management…

    Burns & McDonnell (Akron, OH)
    …Engineer Procure Construct (EPC), Construction Management , Construction, and Program Management projects. The Project Manager leads projects from inception ... **Description** The Project Manager will lead and motivate a team in...will lead and motivate a team in the day-to-day management of project safety, quality, schedule, cost control, contracts,… more
    Burns & McDonnell (09/10/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Akron, OH)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
    Molina Healthcare (09/06/25)
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  • Stakeholder Management Services Department…

    Burns & McDonnell (Columbus, OH)
    **Description** The Stakeholder Management Services Department Manager is responsible for the managerial direction and leadership of a department within a global ... and promoting the Burns & McDonnell culture, values and mission. The Stakeholder Management Services Department Manager will lead the department in a dynamic… more
    Burns & McDonnell (08/08/25)
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  • Continuous Quality Improvement Manager

    National Youth Advocate Program (Columbus, OH)
    ** Utilization Manager /Continuous Quality Improvement Manager - Columbus** **Compensation:** $82,000 - $85,000 **Position Summary** The Utilization ... 401K Matching flexible hours, mileage reimbursement, phone allowance **Responsibilities** The Utilization Manager /Continuous Quality Improvement Manager will… more
    National Youth Advocate Program (09/18/25)
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  • Manager , Healthcare Services

    Molina Healthcare (OH)
    …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and...years in one or more of the following areas: utilization management , case management , care… more
    Molina Healthcare (09/27/25)
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  • Account Manager (Cleveland OH & Pittsburgh…

    J&J Family of Companies (Cleveland, OH)
    …United States **Job Description:** We are searching for the best talent for Account Manager to be in Cleveland, OH & Pittsburgh North PA. **About Surgery** Fueled by ... their journey to wellness. Learn more at https://www.jnj.com/medtech As a Field Sales Account Manager , this individual will serve as the point person for end to end… more
    J&J Family of Companies (09/19/25)
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