- CVS Health (Columbus, OH)
- … clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Columbus, OH)
- …**Must have active current and unrestricted RN licensure in state of residence** ** Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area** **Managed Care experience preferred, especially Utilization Management ** **preference for those residing in EST zones**… more
- Highmark Health (Columbus, OH)
- …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
- Deloitte (Cincinnati, OH)
- Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk ... for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education tools as… more
- Elevance Health (Mason, OH)
- …Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May...an entire clinical program and/or independently performs clinical reviews. + Typically has program management … more
- Elevance Health (Mason, OH)
- …be responsible for an entire clinical program and/or independently performs clinical reviews. + Typically has program management responsibilities including ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. RN Quality Specialist Summary: Ensures the delivery ... education and care with active tracking of high risk patients to decrease utilization .** Essential Functions: + Collaborates and acts as a resource to the… more
- Cleveland Clinic (Cleveland, OH)
- …development. + Act as a consultant in educating and evaluating clinical and support department staff regarding quality management regulations and standards ... using the Cleveland Clinic Improvement Model. You will collaborate with clinical and operational leaders to establish key objectives, ensure compliance with… more
- Cleveland Clinic (Garfield Heights, OH)
- …has occurred. + Act as a consultant in educating and evaluating clinical and support department staff regarding quality management regulations and standards ... compliance with all standards and favorable performance on safety, quality, utilization , and experience metrics. + Participate in engraining the safety, quality,… more