• Clinical Learning Facilitator - Utilization

    Molina Healthcare (OH)
    …Active, unrestricted State RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), ... or state board licensing mandate. + At least 2 years in case , disease or utilization management; managed care; or medical/behavioral health settings. + One year… more
    Molina Healthcare (09/17/25)
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  • Utilization Management Medical Director- NC…

    Elevance Health (Columbus, OH)
    …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be ... ** Utilization Management Medical Director- NC Medicaid** Location: This...and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers… more
    Elevance Health (09/26/25)
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  • Pharmacist, Utilization Management (UM)…

    Molina Healthcare (Dayton, OH)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and cost control issues… more
    Molina Healthcare (09/25/25)
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  • Case Manager (RN or MSW) - Inpatient…

    Select Medical (Dublin, OH)
    …**OhioHealth Rehabilitation Hospital Dublin** A joint venture with Select Medical & OhioHealth ** Case Manager (RN or MSW)** **Benefits of becoming a Case ... and long term disability, and tuition assistance) **Responsibilities** **Position Summary** The Case Manager is responsible for the coordination of health care… more
    Select Medical (09/23/25)
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  • Case Manager - PRN

    Select Medical (Dublin, OH)
    …**OhioHealth-** **Neuro Transitional Center** **Joint venture with Select Medical** **Position:** Case Manager PRN **Location: Dublin, Ohio** **Schedule:** Per ... Diem + We are seeking a Case Manager with rehabilitation experience for an...allotted time frame; assuring payments of services meeting patient-related utilization management criteria, and implementation of safe and appropriate… more
    Select Medical (08/02/25)
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  • Case Manager Extender

    OhioHealth (Columbus, OH)
    …- in our careers and in our communities. **Job Description Summary:** The Case Manager extender works collaboratively with all interdisciplinary staff internal ... correcting inpatient room and bed charges and performing charge reconciliation. The case manager extender is well organized, highly motivated, customer service… more
    OhioHealth (10/02/25)
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  • Case Manager / PRN, Per Diem

    Select Medical (Beachwood, OH)
    **Overview** **Hospital Name:** **Cleveland Clinic with Select Medical** **Position:** Case Manager **Location:** Beachwood, OH **Schedule:** PRN, Per Diem Our ... team of over 44,000 committed to providing exceptional patient care **Responsibilities** The Case Manager is responsible for the coordination of health care… more
    Select Medical (09/20/25)
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  • Clinical Case Manager Behavioral…

    CVS Health (Columbus, OH)
    …required. **Preferred Qualifications** + Crisis intervention skills preferred. + Managed care/ utilization review experience preferred. + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. **Position… more
    CVS Health (09/05/25)
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  • Case Manager , Registered Nurse

    CVS Health (OH)
    …members. **Key Responsibilities** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or ... within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible… more
    CVS Health (10/02/25)
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  • LTSS Service Coordinator - RN Clinician (RN…

    Elevance Health (Toledo, OH)
    **LTSS Service Coordinator - RN Clinician ( Case Manager )** **Hiring statewide across Ohio** **Location** : This field-based role enables associates to primarily ... Service Coordinator-RN Clinician** is responsible for overall management of member's case within the scope of licensure, develops, monitors, evaluates, and revises… more
    Elevance Health (09/12/25)
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