• Utilization Management RN - Specialty…

    Cleveland Clinic (Beachwood, OH)
    …the ideal future caregiver include: + Bachelor of Science in Nursing + Prior Utilization Management experience + Experience in Oncology Our caregivers continue ... with one of the most respected healthcare organizations in the world. As a Utilization Management RN, you will provide a high level of patient care and clinical… more
    Cleveland Clinic (07/31/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Columbus, OH)
    …+ 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . + Consults and lends expertise to other internal and external… more
    CVS Health (07/26/25)
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  • Prior Authorization UM Administration…

    Humana (Columbus, OH)
    …make an impact** **Required Qualifications** + 1 or more years of experience with Utilization Review and/or Prior Authorization + 1 or more years of Healthcare ... experience + Working knowledge of Microsoft Word, Excel, and Outlook. + Live in CST or EST states + Monday-Friday 8am-5pm EST, and work 1 weekend a quarter. Schedule subject to change based on business needs. **Preferred Qualifications** + Bilingual… more
    Humana (07/31/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (OH)
    …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
    Molina Healthcare (07/12/25)
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  • Manager Behavioral Health Services

    Elevance Health (Cincinnati, OH)
    …with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education ... granted as required by law._ This role's primary focus is ABA utilization management The **Manager Behavioral Health Services** is responsible for Behavioral Health… more
    Elevance Health (07/29/25)
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  • Supervisor, Clinical Pharmacy/MTM - Remote

    Molina Healthcare (Dayton, OH)
    …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the unit's… more
    Molina Healthcare (07/09/25)
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  • Senior Analyst, Client Analytics

    Evolent (Columbus, OH)
    …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
    Evolent (06/26/25)
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  • Nurse Reviewer I

    Elevance Health (Mason, OH)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center ... unrestricted RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care… more
    Elevance Health (07/26/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (Columbus, OH)
    …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... 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 (07/27/25)
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  • Utilization Management Representative I

    Elevance Health (Cincinnati, OH)
    ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law._ " The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
    Elevance Health (07/29/25)
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