- Humana (Columbus, OH)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director relies on medical ...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Columbus, OH)
- …scenarios arise from outpatient , inpatient or post-acute care environments. The Medical Director will have discussions with external physicians by phone to ... caring community and help us put health first** The Medical Director relies on medical ...work is assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
- CenterWell (Columbus, OH)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director , Primary Care relies on ...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Columbus, OH)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director actively uses their medical...work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations,… more
- Cardinal Health (Columbus, OH)
- …With over 45 years of experience in helping hundreds of hospital and outpatient pharmacies, we provide access to best practice strategies and tactics to control ... that supports the patient throughout the continuum of care. The Interim Director of Pharmacy will provide leadership on an interim/transitional basis in Cardinal… more
- Medtronic (Columbus, OH)
- …world. **A Day in the Life** In this exciting role as a Sr. Director of Enterprise Accounts (DEA), you will establish trusted partnerships with our most important ... services, and negotiating on behalf of Medtronic-including a strong focus on national contracting across Medtronic portfolios to ensure alignment and execution of… more
- Evolent (Columbus, OH)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call...that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers… more
- Cardinal Health (Columbus, OH)
- …of documentation and coding related to physician or hospital (inpatient and outpatient ) billing and/or medical necessity reviews. + Prepares written reports ... and compliance issues. **Compliance Audit Manager** Reporting to the Compliance Director , this position supervises and manages compliance audits to determine… more
- Molina Healthcare (Columbus, OH)
- …+ Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate. + Maintains compliance with federal, state, ... appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of… more
- Trinity Health (Columbus, OH)
- …Interventional Services Operations Managers and the System Radiology Services Director . Works in collaboration with other Interventional Services Management staff ... **What you will do:** + Works in collaboration with the System Radiology Director according to ACR and Joint Commission standards + Managing Performance: Provides… more
- Trinity Health (Columbus, OH)
- …management database of referrals and treatment plans for Members. + Coordinates with Medical Director /Associate Medical Directors on case-specific issues. + ... Purpose:** The RN Case Manager MCHP is responsible for the coordination of the medical care provided to Plan members with Plan providers, the member's family and… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …be a key member of the Home Based Primary Care team providing outpatient psychological assessment and evidence based psychotherapy to Veterans presenting with a ... and personality disorders. Care is delivered to homebound Veterans with complicated medical diagnoses either in the Veteran's residence or using video telehealth… more
- Datavant (Columbus, OH)
- …HCC is a plus. **You Will:** + Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG and ... results for review by the facility or CCS HIM director . + Review disagreements on APC/DRG changes with the...trauma centers + Experience coding and auditing inpatient and outpatient records for various facilities + Track record of… more