- 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
- 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
- CVS Health (Columbus, OH)
- …phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment ... promote high-quality healthcare for members. **Position Summary** Join a team that's making a difference in the lives of...lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in… more
- CenterWell (Columbus, OH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... and who is interested in being part of a team that focuses on excellent service to others. **Use...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… 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)
- …Minimum of 5 years acute care medical or surgical experience required;** ** Utilization /Case Management , managed care, or Clinical Documentation and ... Through extensive interaction with physicians and other members of the healthcare team , achieves appropriate clinical documentation to support code assignment,… 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
- Centene Corporation (Columbus, OH)
- … and operational groups, including but not limited to: + Care Coordination + Utilization Management + Population Health + Quality + Medical Affairs + Health ... supports the CMO of the Buckeye Community Health Plan and clinical leadership teams by coordinating, organizing, and driving cross-functional initiatives that… more
- Fresenius Medical Center (Columbus, OH)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to… 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
- 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
- Sedgwick (Columbus, OH)
- …FUNCTIONS and RESPONSIBILITIES** + Accesses and assigns cases for medical case management , utilization review and clinical consultation. + Provides ... information to callers based on customer requests; triages telephone calls between utilization review, clinical consultation and telephonic case managers. +… more
- Centene Corporation (Columbus, OH)
- …28 million members as a clinical professional on our Medical Management /Health Services team . Centene is a diversified, national organization offering ... business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality... teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team , medical… 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