- Dayton Children's Hospital (Dayton, OH)
- … TeamSchedule:Part timeHours:8Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical ... 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
- Humana (Columbus, OH)
- …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical… more
- 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 be ... state or territory of the United States when conducting utilization review or an appeals consideration and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Dayton, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Molina Healthcare (Akron, OH)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- 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
- 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
- CenterWell (Mount Vernon, OH)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... our Mount Vernon, OH branch location.** The **RN Clinical Manager ** coordinates and oversees all direct care patient services...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Elevance Health (Columbus, OH)
- **JR167272 Manager Behavioral Health Services** Responsible for overseeing Behavioral Health Utilization Management (BH UM), this position supports the Medicaid ... assist with implementation of cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. + Hires, trains, coaches,… more
- Molina Healthcare (OH)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of integrated… more