- CVS Health (Columbus, OH)
- …as needed for integration of all health care needs and services for OhioRISE Plan 's members. * Assuming key role in quality improvement initiatives, care ... a minimum of 32 hours per week to the OhioRISE Plan 's operations to ensure clinical oversight...Responsible for recommending changes and enhancements to current managed care review guidelines and clinical criteria based… more
- CVS Health (Columbus, OH)
- …clinical case management or crisis intervention as appropriate. + Coordinates and implements assigned care plan activities and monitors care plan ... bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, OhioRISE will help...systems. Evaluation of Members: + Through the use of care management tools and information/data review , conducts… more
- Molina Healthcare (Columbus, OH)
- …+ For OhioRISE Plan enrolled members, Molina will reach out to the OhioRISE Plan and primary care coordination staff to engage the OhioRISE ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...Care Between Molina Healthcare of Ohio and the OhioRISE Plan + Care Coordination… more
- CVS Health (Columbus, OH)
- …referral to medical services staff. - Approve services that do not require a medical review in accordance with the benefit plan . - Performs intake of calls from ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...- Approve services that do not require a medical review in accordance with the benefit plan .… more