• Utilization Management

    CVS Health (OH)
    …No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral health clinical experience in a ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
    CVS Health (01/16/26)
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  • Medical Management Clinician

    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 ... long term services and supports, and psychosocial needs._ The **Medical Management Clinician ** responsible for ensuring appropriate, consistent administration of… more
    Elevance Health (01/17/26)
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  • LTSS Service Coordinator - RN Clinician (RN…

    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 ... and face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral more
    Elevance Health (01/09/26)
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  • LTSS Service Coordinator - Clinician (LSW,…

    Elevance Health (Portsmouth, OH)
    …telephonic or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral ... **LTSS Service Coordinator - Clinician (Case Manager)** **Candidates should live in one...person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial… more
    Elevance Health (01/12/26)
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  • Care Review Clinician (RN)

    Molina Healthcare (OH)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for...for outpatient and inpatient services for the KY Medicaid behavioral health population. Strong post-acute level of care experience… more
    Molina Healthcare (01/15/26)
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  • Payment Integrity Clinician

    Highmark Health (Columbus, OH)
    …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
    Highmark Health (11/14/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Akron, OH)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD,… more
    Molina Healthcare (10/25/25)
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