- CVS Health (Columbus, OH)
- …**Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of the ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- CVS Health (Columbus, OH)
- …Friday, 8:00am to 5:00pm EST with a late shift rotation 10:30am to 7pm EST. Utilization management is a 24/7 operation. Work schedules may include weekends and ... review experience + Medicare experience + Managed Care experience especially Utilization Management + Proficiency with computer skills which includes navigating… more
- CVS Health (Columbus, OH)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in ET zones. **Education**… more
- Guardian Life (Columbus, OH)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- Highmark Health (Columbus, OH)
- …+ Deep Clincal Expertise -extensive knowledge of clinical , quality, care, utilization , high-cost claim, and population health management . Must be a ... Description :** **JOB SUMMARY** This job serves as the sales team's clinical expert, providing high-level support and insights for strategic clients, aligning… more
- Lincoln Financial (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for ... claims. In this role you will act as a clinical resource for Group Protection benefit specialists and claim...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- CenterWell (Columbus, OH)
- … Clinical Pharmacist develops, maintains, and/or operationalizes strategies related to utilization management edits and/or clinical coverage policies for ... provide clinical support across Humana** **Conducts analysis on drug utilization trends to evaluate and inform formulary strategies.** **Collaborates on research… more
- ChenMed (Columbus, OH)
- …rapidly expanding and we need great people to join our team. The Clinical Pharmacist specializing in Population Health is a skilled and proactive professional who ... needed. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Acts as a national pharmacy consultant for our physicians regarding patient case inquiries, drug interactions,… more
- ProMedica Health System (Toledo, OH)
- …department, division, hospital or system level. He/she serves as a consultant , researcher, evidence-based practice mentor, performance improvement leader and project ... nursing in the growth and development of nursing practice through utilization of evidence-based practice concepts and process, the ProMedica Nursing Professional… more
- Elevance Health (Independence, OH)
- … clinical /non- clinical activities. Will also be responsible for utilization review/ management . May be responsible for developing and implementing programs ... and skill development. The **Medical Director** will have program management responsibilities including clinical policy development, program… more