- Insight Global (Mayfield Heights, OH)
- …Agile/Scrum experience Advanced domain knowledge of case, disease and utilization management /coordination/assessments, HEDIS quality and HIE Ability to ... dynamics toward the successful completion of requirements development and management including facilitation of requirements gathering, review, acceptance, prioritization,… more
- Molina Healthcare (Cleveland, OH)
- …trends in drug utilization and identify potential targeted utilization management activities. + Works with Health Care Services (eg, with data manager, ... efficiently and effectively. These pharmacists may also be involved in providing utilization management /prior authorization services. Key duties include any or… more
- CDM Smith (Cleveland, OH)
- …of cloud technologies, including design patterns, planning, configuration, and resource management in Microsoft Azure and other cloud platforms. * Develop DevSecOps ... (AAD), RBAC, IAM configuring role assignments, conditional access, and identity management . * Incorporate security best practices into cloud architecture and ensure… more
- Molina Healthcare (Cleveland, OH)
- …comply with CMS guidelines. These staff may also be involved in providing utilization management /prior authorization services as needed. * Supervises the unit's ... (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy… more
- Molina Healthcare (Cleveland, OH)
- …increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 1-3 Years of experience ... for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist… more
- Molina Healthcare (Cleveland, OH)
- …teams that support one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical ... necessity, etc.), case management , transition of care , health management and/or member assessment. * Typically, through one or more direct report… more
- Molina Healthcare (Cleveland, OH)
- …operational efficiency and decision-making capabilities. * **RAG Pattern Utilization :** Employ retrieval-augmented generation patterns to improve the performance ... teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. * Present complex analytical information to all… more
- Grifols Shared Services North America, Inc (Cleveland, OH)
- …countries and regions. **Overview:** The primary responsibility of the Bleeding Management Hospital Specialty Sales Representative (HSSR) is to represent key ... products within the Bleeding Management product portfolio with a primary responsibility for the...and customer stakeholders to influence uptake for a new standard-of- care and product adoption in the treatment of their… more
- Sanofi Group (Cleveland, OH)
- …of short- and long-term business plans that will optimize appropriate coverage, coding, Utilization Management , payment of and patient access to Sanofi products. ... **Job Title:** Regional Account Director, OH **Location:** Remote /Field Based **About the Job** The Regional Account Director reports to the Regional Accounts Leader… more
- Molina Healthcare (Cleveland, OH)
- …investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable ... to draw conclusions on allegations of FWA and/or may determine appropriateness of care . The SIU Investigator is also responsible for recognizing and adhering to… more
- GE HealthCare (Cleveland, OH)
- …organizations use MIM(R) to give patients more precise, personalized care . https://www.mimsoftware.com/ As a Clinical Application Support Specialist (CASS) you ... training sessions for team members, along with cross-functional teams + Use remote technologies to diagnose and resolve customer concerns and to guide customers… more