- Molina Healthcare (OH)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Elevance Health (Mason, OH)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an impact:** + ... monographs, and formulary recommendations. + Develop strategies to drive formulary utilization and optimization. + Collaborate with account management teams to… more
- Elevance Health (Mason, OH)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
- Elevance Health (Mason, OH)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review** **Virtual:** This role enables associates to work ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… 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 ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more