- CVS Health (Columbus, OH)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position Summary** The ... a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective...projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance… more
- Cognizant (Columbus, OH)
- …considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care ... You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams....care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...to work independently under general instructions and with a team + Must be passionate about contributing to an… more
- Molina Healthcare (Columbus, OH)
- …hearing officer during fair hearings as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… 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
- Elevance Health (Columbus, OH)
- …The ** Clinical Pharmacist** is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, ... **Be Part of an Extraordinary Team ** CarelonRx is a proud member of the...By leveraging the power of new technologies, our strong, clinical -first lens and deep pharmacy expertise, we are actively… more
- Prime Therapeutics (Columbus, OH)
- … clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products and ... **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account Director is responsible for the management of all client… more
- Trinity Health (Columbus, OH)
- …Experience: Minimum of 5 years acute care medical or surgical experience required; Utilization /Case Management , managed care, or Clinical Documentation and ... related to specific documentation requirements. + Collaborates with the multi-disciplinary team , including physicians, patient care services, case management ,… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …is responsible for: 1.Collaborating with the Whole Health Program Manager and Whole health team to: Provide clinical leadership to the Whole Health Program. Plan ... providers. 2. The Clinical Director, in collaboration with the Whole Health team , is responsible for development of clinical whole health interventions: 3.… more
- CenterWell (Columbus, OH)
- …community and help us put health first** The Senior Product Owner - Clinical Referral and Specialty Care is responsible for conveying product vision and roadmap ... to an Agile delivery team by defining user stories and prioritizing product backlog....and prioritizing product backlog. The Senior Product Owner - Clinical Referral and Specialty Care work assignments involve moderately… more
- Hologic (Columbus, OH)
- …analyze, track activity, and provide accurate forecasts. + Leverage internal resource team across Clinical , Sales, Service, Technology and National Accounts to ... Radiology Clinical Account Manager - Columbus, OH Columbus, OH,...this role, you will also build strong relationships with team members and customers - working to uncover and… more
- Prime Therapeutics (Columbus, OH)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Canon USA & Affiliates (Columbus, OH)
- …Complete Alerts and PCR's when applicable. + Provide mid-week update to Applications Management and local Canon Team . **QUALIFICATIONS** + Excellent project ... **XR Clinical Applications Specialist - req1569** **OVERVIEW** This position...and technologists at each location to assure their best utilization of CMSU products and services. + Consult with… more
- Humana (Columbus, OH)
- …to deliver exceptional, person-centered support to members through role-specific care and utilization management activities. This is an opportunity to foster ... caring community and help us put health first** At Humana, our Medicaid Clinical Enablement team is dedicated to designing, developing, and implementing… more
- Evolent (Columbus, OH)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team . We can offer you a meaningful way to make ... You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
- Humana (Columbus, OH)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... Lead Medical Director, depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by… more
- Highmark Health (Columbus, OH)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software**...customer impacts. + Communicate in an exemplary manner with team members, customers, partners and management , including… more
- Evolent (Columbus, OH)
- …meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist ... Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Highmark Health (Columbus, OH)
- …Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team , ensures that utilization management responsibilities are performed in ... accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and...incumbent participates as the physician member of the multidisciplinary team for case and disease management . They… more