- CVS Health (Columbus, OH)
- …insured individuals, providers, claimants, etc. + Analyze and prepare cases for clinical and legal review , ensuring all documentation meets required standards. ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...of three years of Medicaid Fraud, Waste, and Abuse review experience. + Billing and Coding certifications such as… more
- AmeriHealth Caritas (Dublin, OH)
- …us at www.amerihealthcaritas.com. Strong preference of a Ohio resident ;and ;Quality of Care Review experience within a managed care setting. ... minimally necessary medical records are collected and organized for clinical review to occur. Summarizes all ...Bachelor's Degree preferred. + Minimum of 3 years in clinical or service quality improvement/ health care … more
- CVS Health (Columbus, OH)
- …cost-effective outcomes. **Position Responsibilities:** + Through the use of clinical tools and information/data review , conducts comprehensive assessments ... the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member… more
- CVS Health (Columbus, OH)
- …incumbent functions as the Behavioral Health Subject Matter Expert (SME) for the plan and works across various departments including Care Management, Utilization ... leadership team related to Behavioral Health and its integration across the state plan . **Overview:** The Senior Clinical Strategist serves as the primary… more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a...continuum, including behavioral health and long-term care , for members with high need potential. HCS staff… more
- Evolent (Columbus, OH)
- …Participates in the development and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology ... primary care , we seek to ensure that care plans align with clinical evidence, respect... operation initiatives within a progressive and forward-thinking health care organization. + Experience in health plan … more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... (RN) license in good standing. **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Columbus, OH)
- …of Nursing. Bachelor's degree in Nursing preferred. **Required Experience** + 3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in ... the specific programs supported by the plan such as Utilization Review ,...Education** Bachelor's Degree in Nursing **Preferred Experience** 5+ years Clinical Nursing experience, including hospital acute care /medical… more
- CenterWell (Columbus, OH)
- …third party claim rejections by accessing and understanding formulary restrictions, plan limitations, drug utilization review overrides, requesting and ... of our caring community and help us put health first** The Clinical Pharmacy Technician 4 assists the interdisciplinary CIT team with medication-related concerns… more
- Molina Healthcare (Columbus, OH)
- …(HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the ... continuum, including behavioral health and long-term care , for members with high need potential. HCS staff...all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence… more
- EBSCO Information Services (Columbus, OH)
- …Experience in direct patient care required. **What You'll Do** + Write new clinical content topics in several formats for clinical practice tools. + Keep ... Clinical Editor and your development and career growth at EBSCO Information Systems/ Clinical Decisions. **About You** + Direct patient care experience in… more
- Kelly Services (Columbus, OH)
- Market Manager ( Clinical Research) Job Details Job Location: Columbus, OH -...we do. Our Core Values are: ? Quality ? Care ? Be the Change You Seek ? One Team ... enrollment goals. ? Hire and lead the team(s) of Clinical Research Coordinators and other site staff. ? Manage...well. ? Monitor and report KPIs, deeply investigate and plan appropriate actions to resolve KPIs that are off… more
- Cardinal Health (Columbus, OH)
- …(TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy ... to patients who need them-faster.** **_Job Summary_** The Manager, Clinical Operations provides management and clinical oversight...Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings… more
- Cardinal Health (Columbus, OH)
- **_What Specialty Networks contributes to Cardinal Health_** Specialty Networks creates clinical & economic value for independent specialty providers & partners in ... patient outcomes by getting each patient to the right care at the right time. Specialty Networks works with...members and solutions to our industry partners. The _Sr. Clinical Analyst, Member Development (Urology)_ is responsible for supporting… more
- CVS Health (Columbus, OH)
- …Services strategies policies and programs are comprised of network management and clinical coverage policies. Our Care Managers are frontline advocates for ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...the member to facilitate the member's overall wellness. Using clinical tools and information/data review , conducts an… more
- Prime Therapeutics (Columbus, OH)
- …staff and/or pharmacists. + Escalates requests to Pharmacist when request requires extensive clinical review or denial. + Monitors telephone system to ensure ... industry experience, previous reimbursement experience, and/or working in a health plan /health care setting. + In-depth knowledge of specialty injectable… more
- Cardinal Health (Columbus, OH)
- …(TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy ... life-changing therapies to patients who need them-faster.** **_Responsibilities_** The Clinical Operations Supervisor leads program staff performing actions including… more
- CenterWell (Columbus, OH)
- …of our caring community and help us put health first** The RX Clinical Program Professional 1 integrates programs developed to improve overall health outcomes with ... a focus on prescription drugs. The RX Clinical Program Professional 1 work assignments are often straightforward...protection. Please be aware that applicants selected for leader review may be asked to provide a social security… more
- CenterWell (Columbus, OH)
- …of our caring community and help us put health first** The Rx Clinical Programs Pharmacy Technician Representative 2 supports Pharmacists and patients by executing ... helps drive the strategy on comprehensive medication reviews. The Rx Clinical Programs Pharmacy Technician Representative 2 performs varied activities and moderately… more
- CenterWell (Columbus, OH)
- …put patients at the center. As the nation's largest provider of senior-focused primary care , one of the largest providers of home health services, and fourth largest ... patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow… more