- 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
- CVS Health (Columbus, OH)
- … and Utilization Management . AHH delivers flexible medical management services that support cost-effective quality care for members. Utilizes clinical ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- Trinity Health (Columbus, OH)
- …to the UM Program and at the direction of the Sr. Director of Medical Management . + Coordinates with the utilization review, case management , discharge ... 5-7 years of clinical nursing experience with at least 2 years' experience in utilization review or case management . Nursing experience in an HMO insurance… more
- CVS Health (Columbus, OH)
- …day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/ Remote position out of the ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- CVS Health (Columbus, OH)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Molina Healthcare (Columbus, 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
- Evolent (Columbus, OH)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Molina Healthcare (Columbus, OH)
- …+ 3-5 years of experience in case management , disease management or utilization management in managed care , medical or behavioral health settings. + ... to work in a high-volume environment auditing the staff. Remote position Work hours: Monday - Friday: 8:00am to...auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management … more
- Prime Therapeutics (Columbus, OH)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities ... activities including such items as assurance of Service Level Agreement performance in Care Management Centers and Shared Services, assurance of claims accuracy… more
- CDM Smith (Cincinnati, 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
- Prime Therapeutics (Columbus, OH)
- …implementation of innovative drug solutions, including optimizing optimize drug utilization , patient outcomes, and cost-effectiveness through value-based care ... Title** Sr Director Clinical Strategy and Oncology Specialty Solutions- REMOTE **Job Description** The Senior Director Clinical Strategy and...years of work experience within medical and pharmacy drug management within a PBM or managed care … more
- Highmark Health (Columbus, OH)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...management process are consistent with community standards of care . + Participate as a member of the CMDM… more
- Prime Therapeutics (Columbus, OH)
- …notifications, and periodic reports related to licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, ... every decision we make. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** Job Description The Senior Compliance Analyst assists in the… more
- Prime Therapeutics (Columbus, OH)
- …notifications, and periodic reports related to licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, ... **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance Analyst assists in the… more
- Prime Therapeutics (Columbus, OH)
- …**Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst - Remote **Job Description** The Senior Health Data Analyst provides information, analyses, and ... GED is required + 5 years of experience in pharmacy benefits management , reporting & analytics, benefits consulting, healthcare, financial services or related field… more
- Prime Therapeutics (Columbus, OH)
- …every decision we make. **Job Posting Title** Principal Underwriter - REMOTE **Job Description** The Principal Underwriter is responsible for achieving profit, ... guarantees and other financial considerations. **Responsibilities** + Evaluates the utilization and financial experience of customers and prospects; primarily… more
- Prime Therapeutics (Columbus, OH)
- …decision we make. **Job Posting Title** Sr. Director Actuarial Forecasting - REMOTE **Job Description** The Senior Director of Actuarial Forecasting leads a team ... complex actuarial modeling + Collaborates with underwriters, client engagement, and senior management on RFP process and other pricing initiatives related to all… more
- Sharecare (Columbus, OH)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... and for intervening with the participants and their Primary Care Provider according to the disease management ...Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is… more
- Molina Healthcare (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 (OH)
- …with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics To all current Molina employees: ... + Develops custom health plan reports related to managed care data like Medical Claims, Pharmacy, Lab and HEDIS...of data + 3-5 years of experience in Managed Care Organization executing similar techno functional role that involves… more