- Ryder System (Columbus, OH)
- …of assigned staff. Assists Director with other staff as directed. Work with Director and other management team to develop tactics and strategies to achieve ... staff. Handles commercial lines bodily injury and property damage claims as well as insurance and contractual coverage issues....annual metrics and other KPI's + Participates with the Director in the selection and management of… more
- CVS Health (Columbus, OH)
- …during the plan year. The **Medicare** **Benefits Standards & Guidance Lead Director ** ensures accountability for the implementation, management , and maintenance ... Employer Groups. The **Medicare** **Benefits Standards & Guidance Lead Director ** acts as the point of contact to our...such as Benefit & Product Strategy, Benefits & Product claims configuration, Medicare Service Operations (MSO), Medical … more
- Humana (Columbus, OH)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
- Humana (Columbus, OH)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Columbus, OH)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- CVS Health (Columbus, OH)
- …cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... services to its membership. Aetna is looking for a medical director to be part of a...licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health… more
- Centene Corporation (Columbus, OH)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Molina Healthcare (Columbus, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Sedgwick (Columbus, OH)
- …of education and experience required to include five (5) years of relationship building in the claims management or risk management . + Must reside in one of ... Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Business Development Director **PRIMARY PURPOSE OF THE ROLE:** To expand and enhance the… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr. Director Underwriting ... for prospective clients and new customer acquisitions. **Responsibilities** + Analyze claims data and develop cost-of-care projections for existing customer renewals… more
- Sedgwick (Columbus, OH)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Marketing Analytics Director **PRIMARY PURPOSE OF THE ROLE:** The Marketing Analytics Director ... growth opportunities + A diverse and comprehensive benefits offering including medical , dental vision, 401K, PTO and more Work environment requirements for… more
- Molina Healthcare (Columbus, OH)
- …* Proficiency in Microsoft Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, ... from root cause analysis through implementation * Oversees vendor FWA case management including tracking on schemes, coordinating internal efforts with vendor to… more
- Trustmark (Columbus, OH)
- …+ Collaborate with the sales leadership teams of VP of Sales & Client Management , Senior Directors' Sales, and the whole sales team to maximize opportunities. + ... accounting of activities and sales. + Collaborate with and support the Client Management team to assure persistency goals are being achieved. + Review national… more
- CVS Health (Columbus, OH)
- …and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense ... + Promotes communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers, and health care… more
- CVS Health (Columbus, OH)
- …and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense ... + Promotes communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers, and health care… more
- Trinity Health (Columbus, OH)
- …policies, and procedures as assigned. + Assists Director and/or Sr. Director with the Medical Delivery Systems budget. + Manages successful implementation ... thing. **What we offer:** + Competitive compensation and benefits packages including medical , dental, and vision coverage + Retirement savings account with employer… more
- Molina Healthcare (Columbus, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... system requirements of customers as it pertains to contracting, network management and credentialing. **Knowledge/Skills/Abilities** * In conjunction with the … more
- UMB Bank (Columbus, OH)
- …across all payment channels. Will work with the Enterprise Fraud Prevention and Claims teams to provide data to help identify emerging fraud trends and UMB's ... concert with the Enterprise Fraud Prevention and Enterprise Fraud Claims teams to identify fraud exposure and make necessary...to fulfill overall business needs and expectations of the Director of Enterprise Fraud Operations and the bank's senior… more
- Prime Therapeutics (Columbus, OH)
- …understanding of pharmaceutical claims data and general understanding of medical claims data; highly analytical + Experience identifying opportunities for ... and leadership expectations. + Serves as a consultant to management on major matters pertaining to laws and regulations,...ability to adjust focus **Reporting Structure** + Reports a Director in the Compliance department Potential pay for this… more
- Cardinal Health (Columbus, OH)
- …on policies. **_Manager, Ethics and Compliance_** Reporting to the Compliance Director , this position is responsible for supporting the programmatic requirements for ... focus include: compliance training, policy development, exclusion screening tracking, management of investigations and development of programmatic presentation materials.… more