- Highmark Health (Columbus, OH)
- …Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **ESSENTIAL RESPONSIBILITIES** + Provide ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- Highmark Health (Columbus, OH)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management… more
- Sharecare (Columbus, OH)
- …members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management… more
- Highmark Health (Columbus, OH)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Elevance Health (Cincinnati, OH)
- …an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing ... work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England… more
- Elevance Health (Canton, OH)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... competent, person‐centered coordination for all members that addresses physical health , behavioral health , long term... care team, to ensure cost effective and efficient utilization of health benefits. + Decision making… more
- Molina Healthcare (OH)
- …Masters Degree in Behavior Analysis or a related field. **Preferred Experience** Utilization Management experience Health Plan/MCO work experience ... an integrated delivery of care across the continuum, including behavioral health and long term care, for...requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide… more
- Highmark Health (Columbus, OH)
- …terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- Army National Guard Units (Columbus, OH)
- …you will perform the following duties: 1. Exercises supervisory personnel management responsibilities. Advises and provides counsel to employees regarding policies, ... procedures, and directives of management . Selects or recommends selection of candidates for vacancies,...action to correct situations posing a threat to the health or safety of subordinates. Applies EEO principles and… more
- Highmark Health (Columbus, OH)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job will manage small scale projects and enhancement packages with mentorship and leadership ... from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval through to… more