- Elevance Health (Mason, OH)
- ** Medical Management Clinician Sr.** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... management , human resource consulting and retirement benefits administration services. The ** Medical Management Clinician Sr.** is responsible for… more
- Elevance Health (Cincinnati, OH)
- ** Medical Management Clinician ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... behavioral health, long term services and supports, and psychosocial needs._ The ** Medical Management Clinician ** responsible for ensuring appropriate,… more
- Elevance Health (Portsmouth, OH)
- **LTSS Service Coordinator - Clinician (Case Manager)** **Candidates should live in one of the following counties:** Athens, Auglaize, Defiance, Gallia, Hocking, ... term services and supports, and psychosocial needs. The **LTSS Service Coordinator- Clinician ** is responsible for working under the direction/supervision of an RN,… more
- Elevance Health (Columbus, OH)
- …an accommodation is granted as required by law._ The **LTSS Service Coordinator-RN Clinician ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN Clinician (Case Manager)** **Hiring in the following counties: Delaware, Fayette, Franklin, Fairfield, Licking, Madison, Pickaway,… more
- CVS Health (OH)
- …to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically ... evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. + Utilizes clinical experience and… more
- Molina Healthcare (OH)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work hours are Monday-Friday… more
- Highmark Health (Columbus, OH)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of ... or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment and retrospective… more
- Molina Healthcare (OH)
- …license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.… more
- Molina Healthcare (OH)
- …Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.… more
- Molina Healthcare (Cleveland, OH)
- …* Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2 years… more