- Highmark Health (Columbus, OH)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving key technical ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements for… more
- Battelle Memorial Institute (Columbus, OH)
- …working in a dynamic, mission-driven environment. This position supports outpatient behavioral health activities by conducting intake interviews, assisting with ... + Assist with the management and treatment of outpatient behavioral health activities + Under the supervision...therapeutic procedures under the guidance of a licensed mental health professional + Complete initial intake interviews… more
- Bon Secours Mercy Health (Youngstown, OH)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... directs patient teaching activities and coordinates the care provided by health team members. **Essential Job Functions** In collaboration with the interdisciplinary… more
- Elevance Health (OH)
- …informed, culturally competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term services and ... plan. Engage the individual's support network and oversee management of their physical health , behavioral health , and long-term services and supports,… more
- Highmark Health (Columbus, OH)
- …effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and… more
- Elevance Health (Marietta, OH)
- …informed, culturally competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term services and ... the identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term… more
- Highmark Health (Columbus, OH)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... design efforts. + Develop and foster relationships across Highmark and with professional organizations, user groups and industry trade groups to stay current with… more
- Highmark Health (Columbus, OH)
- …SUMMARY** This job requires the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Elevance Health (Columbus, OH)
- …informed, culturally competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term services and ... evaluation, coordination and management of member's needs, including physical health , behavioral health , social services... care team, to ensure cost effective and efficient utilization of health benefits. + Decision making… more
- Highmark Health (Columbus, OH)
- …agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees. ... designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret… more