- 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
- 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
- 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
- Merck (Columbus, OH)
- …support, educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications, Skills & ... days may vary by site or organization, with Friday designated as a remote -working day, unless business critical tasks require an on-site presence.This Hybrid work… more
- Molina Healthcare (Dayton, OH)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...providers when overpayments are identified. + Works may be remote , in office, and on-site travel within the state… more