- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... discharge plan. + Achieve a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day. +… more
- Mallinckrodt Pharmaceuticals (Cleveland, OH)
- Job Title Immunology Sales Specialist - Ophthalmology (Cleveland/Pittsburgh) Requisition JR000015416 Immunology Sales Specialist - Ophthalmology ... ability to drive results across large and complex territories. This specialist will overlay existing field teams, collaborating closely with portfolio… more
- Mallinckrodt Pharmaceuticals (Cleveland, OH)
- Job Title Immunology Sales Specialist - Nephrology (Cleveland) Requisition JR000015411 Immunology Sales Specialist - Nephrology (Cleveland) (Open) Location ... ability to drive results across large and complex territories. This specialist will overlay existing field teams, collaborating closely with portfolio… more
- Cleveland Clinic (Cleveland, OH)
- …organizations in the world. As a Safety, Quality and Patient Experience (SQPE) Specialist II at Lutheran Hospital, you will help drive excellence across a diverse ... ensure compliance with standards and improve performance across safety, quality, utilization and experience metrics. This is an exciting opportunity to advance… more
- FirstEnergy (Akron, OH)
- …a subsidiary of FirstEnergy Corp. [SC00] **Position Summary** The Fleet Technical Specialist plays a key role in supporting and enhancing FirstEnergy's Fleet ... Management application (M5), while also contributing to broader fleet...utility compliance standards. + Monitor system KPIs such as utilization , availability, and outage duration. + Provide actionable insights… more
- Robert Half Accountemps (Richfield, OH)
- Description We are seeking a detail-oriented and skilled Accounts Payable Specialist to join our team in Richfield, Ohio. This Contract-to-Permanent position ... the broader business functions. Key Responsibilities: + Accounts Payable Management : + Process full-cycle accounts payable, including three-way matching and… more
- Molina Healthcare (Cleveland, OH)
- …clinical systems applications/platforms. Responsible for implementation and training delivery for utilization management , care management , long-term services ... in clinical systems analysis, and 1 year experience in a care management , utilization management , behavioral health, medical, or managed care setting, or… more
- Molina Healthcare (Cleveland, OH)
- …system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. This role is a multi facet internal ... training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions + Generates and prepares provider-related data and… more
- Danaher Corporation (Cleveland, OH)
- …includes some of the following: infection detection/control, sepsis care, decision support, utilization management , case management , ED patient workflow, ... leaders from nursing, emergency medicine, pharmacy, quality, patient safety, risk management , IT, infection control, laboratory, and administration is required. This… more
- Molina Healthcare (Cleveland, OH)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Molina Healthcare (Cleveland, OH)
- …ensure payment integrity. * Performs clinical reviews of medical records and other utilization management documentation to evaluate issues of coding and DRG ... tools to build workflow processes and training, auditing and production management resources. * Identifies potential claims outside of current concepts where… more
- Molina Healthcare (Cleveland, OH)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred. Work… more
- Molina Healthcare (Cleveland, OH)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... work of external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative to business needs.… more
- Burns & McDonnell (Akron, OH)
- …manage the execution of transmission line projects, be a subject matter specialist , and be a technical lead/author on routing/siting studies, environmental studies ... Practice to perform the following primary duties: + Project management , team leadership, and mentoring of junior staff. +...and the ability to effectively balance direct and indirect utilization rates. + Minimum of 7 years of experience… more
- Cleveland Clinic (Warrensville Heights, OH)
- …safety, quality and experience. As a Safety, Quality and Patient Experience (SQPE) Specialist - Sepsis Coordinator, you will play a critical role in advancing our ... compliance with all standards and favorable performance on safety, quality, utilization , and experience metrics. + Participate in engraining the safety, quality,… more