- UC Health (Cincinnati, OH)
- UC Health is hiring a Part-Time Lead Access Coordinator within the Utilization Review department for the First Shift that is Remote within the Greater ... The Lead Access Coordinator supports verification of insurance coverage utilization different on-line modalities for clinic patients receiving diagnostic testing… more
- Humana (Columbus, OH)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs basic administrative,… more
- CenterWell (Columbus, OH)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Columbus, OH)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Humana (Columbus, OH)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... PH ,UM Administration Coordinator 2 contributes to administration of PH utilization management. The UM Administration Coordinator 2 provides non-clinical support for… 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 ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Insight Global (Blue Ash, OH)
- …execution roadmaps, and effectively communicating with stakeholders This role is remote , but requires frequent domestic travel for in-person collaboration. The ... manage inbound requests, ability to adhere to Product Lifecycle standards, and/or utilization of Aha according to defined best practices. This may include tracking… more
- Molina Healthcare (Toledo, OH)
- …healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare ... utilization and cost containment reports and makes recommendations based...ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing… more
- Prime Therapeutics (Columbus, OH)
- …make. **Job Posting Title** Pharmacy Trade Relations Strategy Director - remote **Job Description** The Pharmaceutical Trade Relations Strategy Director facilitates ... key internal stakeholders including Clinical, Clinical Program Management, and Utilization Management to deliver financial opportunities to Prime's clients.… more
- Molina Healthcare (Columbus, OH)
- …Molina Healthcare is hiring for several Pharmacy Technicians. These roles are 100% Remote and require you be licensed either State or Nationally. These positions ... those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such… more