- UC Health (Cincinnati, OH)
- …therapy and/or surgical procedures. The associate is responsible for obtaining prior authorization requests and/or pre-determination for these services to ... and diverse place of employment. Verification of insurance coverage utilization different on-line modalities for clinic patients receiving diagnostic testing… more
- Molina Healthcare (Cincinnati, OH)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- Molina Healthcare (Dayton, OH)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management / prior authorization services as needed. * Supervises the… more
- Molina Healthcare (OH)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Evolent (Columbus, OH)
- …Analyst, Scope Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent ... and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work...impactful manner. + Perform other duties related to the management of prior authorization and… more
- Molina Healthcare (Columbus, OH)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... through Friday from 1230pm to 9pm MST. Molina Pharmacy Services/ Management staff work to ensure that Molina members have...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
- Humana (Columbus, OH)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
- CenterWell (Columbus, OH)
- …Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a ... help facilitate clinical medication review decision making. + Responsible for operationalizing prior authorization criteria into Humana systems in alignment with… more
- Evolent (Columbus, OH)
- …teams and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and ... insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman).… more
- Air National Guard Units (OH)
- …of primary responsibility (OPR) for implementing procedures required in the management and operation of CES unique work control systems. Estimates requirements ... to maximize productivity. Coordinates with Material/Deployment Manager on assignment and utilization of all vehicles and equipment assigned to CES for the… more
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