- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. ... Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation... program. + Act as a primary liaison with plan providers including but not limited to physicians, hospital… more
- CVS Health (Columbus, OH)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors… more
- CVS Health (Columbus, OH)
- …work CST or EST Preferred. **Primary Duties and Responsibilities:** * Provides clinical oversight of the Dual Eligible Special Needs Plan (DSNP) and ... Medicare-Medicaid Plan (MMP) care management teams and the Interdisciplinary Care Team (ICT) processes by participating in the development of members' Individual… more
- CVS Health (Columbus, OH)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... Director will be responsible for provider education regarding best clinical practices, utilization management , care management , claims adjudication, pharmacy… more
- AmeriHealth Caritas (Columbus, OH)
- …assists in the development of Medical Necessity Criteria and performs utilization management activities. Assures that organizational medical policies and ... The Behavioral Medical Director reviews and approves the Outcomes Management and Quality Improvement Plan . This position...management experience desired + Experience in crisis intervention, utilization management and benefit plans. S +… more
- CVS Health (Columbus, OH)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods and treatment protocols for DSNP/MMP ... Behavioral Health, Pharmacy, member outreach, Care Management , National Quality Management , Utilization Management , Compliance, and other departments to… more
- Battelle Memorial Institute (Columbus, OH)
- …Oversees development of major program plans covering the strategic business plan , technical content, program management best practices, program acquisition ... function of dollar volume or contract length. Provides successful leadership and management to programs with high client and/or Battelle impact and investment.… more
- Elevance Health (Columbus, OH)
- …and cost-effectiveness. **How you will make an impact:** + Ideation, development and oversight of programs that optimize medication management and reduce overall ... **Pharmacist Program Manager** will lead initiatives to manage and optimize drug utilization , improve patient health outcomes, and control costs for chronic health… more
- CVS Health (Columbus, OH)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... coverage and policies. The Manager, Clinical Health Services is responsible for oversight and management of clinical team processes including the organization… more
- Prime Therapeutics (Columbus, OH)
- …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... stakeholders through effective consultative services. **Responsibilities** + Coordinate formulary management for the client including, client specific Pharmacy &Therapeutics… more
- Cardinal Health (Columbus, OH)
- …lines directly or in partnership with other leaders. Responsibilities also includes oversight and management of credentialing functions. This position reports to ... the future. The Director, Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible… more
- Verint Systems, Inc. (Columbus, OH)
- …of Job Function:** Responsible for the strategic direction, alignment, design and oversight of all benefit plans for US, Canada, Mexico and Brazil employees. ... ongoing analysis of the health benefits strategy - including plan design, pricing strategy, administration, compliance, communications, implementation and… more
- Prime Therapeutics (Columbus, OH)
- …Excellent verbal and written communication skills. + Knowledge of legislative/ oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers ... client presentations + Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and analytics… more
- Burns & McDonnell (Columbus, OH)
- …contracts, subcontractors, suppliers, proposals, estimates, documentation turnover, client relations/ management , field staff and other duties required to execute ... EPC, Construction Management , Construction, and Program Management projects. Experience...project team members and subcontractors. + Responsible for the oversight of day-to-day construction activities and the successful execution… more
- Battelle Memorial Institute (Columbus, OH)
- …Toxicologist functions as a study director within the organization and has oversight of the scientific elements of projects to ensure successful implementation ... projects/research. This position may also be responsible for the supervision, oversight , scheduling, training, and mentoring of individuals within Battelle's Life… more
- Post Holdings Inc. (West Jefferson, OH)
- …forecasting and full P&L responsibility for the location. This role has oversight of accounts payable, inventory costing, and SOX compliance. The Controller is ... Payable. Lead development of monthly forecasts, and the Annual Operating Plan . Maintain customer relationship related to financial aspects including pricing and… more
- Intermountain Health (Columbus, OH)
- …analysis and total cost of ownership understanding and analysis, implements demand management strategies, utilization management strategies and supply ... Intermountain Healthcare. (c) This position also manages key stakeholder relationship management (CRM), coordinating complex and critical projects in the supply… more
- Battelle Memorial Institute (West Jefferson, OH)
- …Summary** The Manager, Facilities Alterations, Operations & Maintenance provides oversight of the Facilities Alterations, Operations and Maintenance Department which ... provides services such as building automation controls and energy management , electrical construction and distribution, utilities, mechanical systems repairs and… more
- CVS Health (Columbus, OH)
- …consistent responses to members and providers. In addition you will oversee utilization review/quality assurance, directing case management . In this role you'll ... without encumbrances.** In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in the development,… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- … management , decision-making, policy development, and resource allocation and utilization for the Service. The incumbent plans and/or accomplishes special ... standards, please visit the United States Office of Personnel Management 's website at https://www.opm.gov/policy-data- oversight /classification-qualifications/general-schedule-qualification-standards/. Education Education for… more