• Manager, Clinical Data Acquisition ( Remote…

    Molina Healthcare (Cincinnati, OH)
    …process, including HEDIS, state-based measure reporting and medical record review . + Manages annual HEDIS data collection activities. Responsibilities include ... reports including performance measurement rates. + Manages medical record review and performance measurement reporting projects for assigned area(s) ensuring… more
    Molina Healthcare (08/31/25)
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  • Client Success Manager - Remote

    Sharecare (Columbus, OH)
    …services + Uses technical and business development skills to increase client's utilization of current technology + Tracks, analyzes, creates, and delivers relevant ... collaboration with Director Client Success the QBR and Annual Review **Reporting** + Collaborate with the reporting team to...and dashboards and deliver monthly, quarterly and annually + Review and analyze reports for accuracy and outcomes needed… more
    Sharecare (08/23/25)
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  • Quality Control Specialist - Remote

    Sharecare (Columbus, OH)
    …producing quality work at all times. **Essential Job** **Functions:** + Review electronic records for HIPAA compliance, compliance with request and authorization ... limits. + Review documentation and determine if there is a legal...rules and regulations. + Meet established production, quality, and utilization goals. + Support other queues as needed to… more
    Sharecare (08/21/25)
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  • Clinical Documentation Specialist - Remote

    Trinity Health (Columbus, OH)
    …**Shift:** Day Shift **Description:** The Clinical Documentation Specialists will concurrently review medical records and assist physicians in removing the barriers ... Minimum of 5 years acute care medical or surgical experience required; Utilization /Case Management, managed care, or Clinical Documentation and experience in ICD-10… more
    Trinity Health (09/30/25)
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  • Disease Management Nurse - Remote

    Sharecare (Columbus, OH)
    …techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also ... in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency tests are required for all Sharecare clinicians.… more
    Sharecare (09/13/25)
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  • Senior Analyst, Healthcare Analytics - Risk…

    Molina Healthcare (Cleveland, OH)
    …multiple data sources, crosswalks, and built-in validation checks. + Use peer-to-peer review process and end-user consultation to reduce errors and rework. + Assist ... Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare + Advanced knowledge of Databricks +… more
    Molina Healthcare (08/14/25)
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  • Senior Analyst, Healthcare Analytics (Risk…

    Molina Healthcare (OH)
    …requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework + Practice ... + Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare + Advanced knowledge of SQL + Proficient… more
    Molina Healthcare (07/17/25)
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  • Assistant Medical Director

    Medical Mutual of Ohio (OH)
    …to achieve goals.** **Responsibilities:** + Provides clinical expertise to the utilization review process and determinations. + Provides pre-determination ... principles. + Knowledge of health plan claims adjudication and utilization review processes preferred. Medical Mutual is...keyboard, mouse and headset. + Whether you are working remote or in the office, employees have access to… more
    Medical Mutual of Ohio (10/02/25)
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  • Medical Director - Claims Management

    Humana (Columbus, OH)
    …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (09/17/25)
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  • Medical Director - Southeast Region

    Humana (Columbus, OH)
    …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (09/10/25)
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