- 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
- Highmark Health (Columbus, OH)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… 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
- Cognizant (Columbus, OH)
- …guidelines and regulations. * Experience in the analysis and processing of claims, utilization review /quality assurance procedures. * Must be able to work with ... flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United States. Regardless of… more
- Wolters Kluwer (Columbus, OH)
- …opportunities in the named customer base, including: + Conducting regular account review meetings and reviewing account utilization management reporting to ... **_ This is a remote position covering the New England territory _**...communication **Travel Requirements** + 25-50% within territory \#LI - Remote _Applicants may be required to appear onsite at… more
- Prime Therapeutics (Columbus, OH)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... every decision we make. **Job Posting Title** Infusion Referral Nurse- REMOTE **Job Description** Under supervision, is responsible for performing referral services… more
- Optiv (Cleveland, OH)
- _This position will be fully remote and can be hired anywhere in the continental US_ The Practice Manager is a key leadership role within our Services consulting ... documented, up to date, and consistently applied across all projects + Review and approve project deliverables for accuracy, completeness, and alignment with… more
- Actalent (New Albany, OH)
- …with engineering and design production leadership teams to plan, execute, and review client funded projects. Communicate all relevant activities and action plans to ... requirements are documented and accurately assigned to facilitate maximum efficient utilization and meaningful capacity planning. + Prepare regular financial and… more
- Prime Therapeutics (Columbus, OH)
- …we make. **Job Posting Title** Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr Director, Pharmaceutical Trade Relations is responsible for ... including items such as manufacturer and GPO negotiation, rate and utilization management policy creation and interpretation, formulary modeling and pull through… more
- Acosta Group (Dayton, OH)
- …to successfully sell principals' specific programs and initiatives. + **Strategic Utilization :** Leverage insights from Senior Vice President, General Manager, Team ... business. + **Information Management:** Maintain current account distribution information, review market pricing reports for accuracy and competitive activity, and… more