- Humana (Columbus, OH)
- …and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity ... required. Mandatory overtime during peak season.** **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT)...**Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Wellpath (Cleveland, OH)
- …point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case management ... a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison… more
- Sedgwick (Columbus, OH)
- …to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. **ARE YOU AN IDEAL CANDIDATE?** We are ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Utilization Review Coordinator **PRIMARY PURPOSE** : To assign ...+ Enters demographics and UR information into claims or clinical management system; maintains data integrity. +… more
- CenterWell (Columbus, OH)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- Humana (Columbus, OH)
- …Pharmacist Principal develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Fresenius Medical Center (Lima, OH)
- …as a resource to facility staff . + Provides counseling for all clinical staff members at regular intervals offering support and encouraging professional ... to the disease management company. Maintains current knowledge of disease management software and systems as pertinent. ** STAFF :** + Responsible for… more
- Highmark Health (Columbus, OH)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Deloitte (Cincinnati, OH)
- …plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education ... clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …Collaborate with other HBPC Medical Directors, VISN leadership, and VA Central Office staff on program development issues. Clinical Responsibilities Clinical ... Summary The Physician will be appointed to the medical staff at the VA Central Ohio Healthcare System and...into medical practice. Will collaboratively work with other pain management providers to establish evidence-based utilization of… more