- Wellpath (Cleveland, OH)
- …for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- Humana (Columbus, OH)
- …reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Columbus, OH)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Columbus, OH)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Sevita (Lyndhurst, OH)
- …DSPs in documenting incident reports; submits initial incident reports to the Program Director . 8. Billing and Utilization : Compiles or accumulates census or ... on a daily basis; maintains 3. Program Planning: Assists the Program Director in development of individual program plans; trains and monitors implementation of… more
- Molina Healthcare (Dayton, OH)
- …years as a medical director in managed care setting supporting utilization management /quality management initiatives, or equivalent combination of ... of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. * Recruits, hires,… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …promotional execution, and omnichannel engagement to drive awareness, adoption, and utilization among HCPs. The Director will work cross-functionally with ... **Position Summary** The Director , HCP Marketing Lead guides the healthcare provider (HCP) engagement strategy for Centanafadine, a novel launch product for ADHD.… more
- CVS Health (Columbus, OH)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you'll ... specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management ...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Evolent (Columbus, OH)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
- Centene Corporation (Columbus, OH)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more