- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your ... 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)
- …Plan . * Serving as the chair or co-chair of the Utilization Management committee and of the OhioRISE Plan 's internal quality improvement committee. * Play ... minimum of 32 hours per week to the OhioRISE Plan 's operations to ensure clinical oversight and...management , and quality improvement components of the OhioRISE Plan . * Developing, implementing, and interpreting medical policies and… 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
- 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
- RES (Columbus, OH)
- …of mechanics, shop aligned and site/field-based, and is responsible for oversight , direction, troubleshooting, diagnosing and high-quality repairs on heavy equipment ... routine maintenance schedules and communicates schedules for maintenance, repairs and utilization to Equipment Manager and field personnel. + Reviews third (3rd)… 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 ... in the US.** In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in the development, implementation, and… more
- Merck (Columbus, OH)
- …Performance across a portfolio of our Company products + Ensuring proper oversight and compliance with our Company policies and exercising appropriate financial ... (revenue/expenses) for the Payer business. + Customer Account Planning and Management + Accountable for payer customer/portfolio P&L (revenue and expenses); works… more
- BJs Wholesale Club (Lewis Center, OH)
- …needs* o Three medical plans**, Health Savings Account (HSA), two dental plans, vision plan , flexible spending * 401(k) plan with company match (must be ... in the execution and delivery of exceptional service and value. Provide TM oversight and direction to exceed performance expectations and results in each area… more
- Prime Therapeutics (Columbus, OH)
- …use of innovative actuarial modeling concepts. This position will provide direct oversight to both the rebate and trend projection process, including recommendations ... complex actuarial modeling + Collaborates with underwriters, client engagement, and senior management on RFP process and other pricing initiatives related to all… more
- Trinity Health (Grove City, OH)
- …proper prioritization of emergent add-ons. Ensures patients/family are updated as to the plan of care and/or delays. + Documentation: Oversight of complete and ... , a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive outreach and community wellness programs, Mount… more
- CESO, Inc. (Columbus, OH)
- …oversees all aspects of technical responsibilities, including QC, scope and fee management , and development/growth of staff within a Business Unit. You will have ... * Responsible for the architecture team budget, labor hour utilization , and participating in development of best practice standards...provide feedback and/or redlines for others to address * Management and guidance of the team's overall flow and… more