- 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
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such as admission, ... ONLY: Must be FL resident** Join the Cleveland Clinic team where you will work alongside passionate caregivers and...a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a… 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
- Danaher Corporation (Cleveland, OH)
- …includes some of the following: infection detection/control, sepsis care, decision support, utilization management , case management , ED patient workflow, ... - innovating at the speed of life. As a global leader in clinical diagnostics, Beckman Coulter Diagnostics has challenged convention to elevate the diagnostic… more
- CenterWell (Marion, OH)
- …requires you to sit on-site at our Marion, OH branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. This role is a focused on both...in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care… more
- Elevance Health (Seven Hills, 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
- Deloitte (Cincinnati, OH)
- …both formal and informal education of physicians, CDI team , health information management and other clinical staff + Develop in-service education tools as ... Keep up to date with advancements changes in regulations pertaining to coding, clinical documentation and health information technology The Team : Our Enterprise… 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
- Bon Secours Mercy Health (Cincinnati, OH)
- …**Essential Functions:** + Activities may include but are not limited to medication management activities typically for a specific clinical area of focus or ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. As a faith-based and patient-focused organization,… 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
- Bon Secours Mercy Health (Youngstown, OH)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Primary Function/General Purpose of Position** The ... Clinical Pharmacy Specialist participates in clinical programs...disease prevention + Perform medication reviews and medication therapy management to ensure safe and appropriate use of medications… 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 (Youngstown, 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