- Elevance Health (Mason, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Molina Healthcare (Dayton, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Banner Health (OH)
- …make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the ... in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction… more
- Elevance Health (Chillicothe, OH)
- **LTSS Service Coordinator (Case Manager )** **Hiring near Cambridge, Colerain, Chillicothe, Coschocton, Hillsboro, Ironton, Mansfield, Marion, Mount Orab, Mount ... chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. + At the direction of… more
- Elevance Health (Mason, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Pharmacist Program Manager ** **Hybrid 1:** This role requires associates to...education programs. + Assists in developing formularies. Performs drug utilization analyses. + Participates in and presents to Pharmacy… more
- Molina Healthcare (Columbus, OH)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- Molina Healthcare (OH)
- …modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim… more
- Elevance Health (Cincinnati, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Sharecare (Columbus, OH)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Elevance Health (Lima, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... May be responsible for developing and implementing programs to improve quality, utilization trends, and member outcomes. May provide clinical consultation and serve… more