- Evolent (Columbus, OH)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- 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
- Kemper (Columbus, OH)
- Location(s) Jacksonville, Florida, Remote -AL, Remote -CT, Remote -FL, Remote -GA, Remote -IL, Remote -IN, Remote -OH, Remote -PA, Remote -WI ... complex technical problems and issues with assigned applications and work processes. + Review and recommend test plans for impacted areas and end to end test… more
- 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
- Molina Healthcare (Cleveland, OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... be licensed for the state they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with a… more
- Humana (Columbus, OH)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Arrow Electronics (Dayton, OH)
- …design, product and proof of concept demonstrations, solution consultation, architecture review , and enablement of Arrow partners. The SED possesses a background ... Solutions Lab as a key differentiator for Arrow. Drive utilization through technology demonstrations, POCs, and innovation tied to...to assist in closing a deal. **Work Arrangement:** Fully Remote : Must be able to travel to an Arrow… more
- Veterans Affairs, Veterans Health Administration (Akron, OH)
- …Duties: Schedules patient appointments Coordinates with the patient care team to review the clinic utilization by using various reports; Maintains effective ... Monday - Friday, 8a - 4:30p Telework: Not available Remote : This is not a remote position....delivery model. Coordinates with the patient care team to review clinic appointment availability utilization ) to ensure… more
- Humana (Columbus, OH)
- …health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present educational… more
- Datavant (Columbus, OH)
- …use cases and volume + Drive adoption of modernized workflows include Global and Remote processing + Maintain high customer retention and satisfaction as a partner + ... benchmarking, goal setting, timely execution, and superior leadership. + Strong utilization of SalesForce to include monitoring and documenting member information. +… more