- Elevance Health (Cincinnati, OH)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
- Elevance Health (Cincinnati, OH)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Molina Healthcare (Covington, KY)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Covington, KY)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Covington, KY)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management...**REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3… more
- Molina Healthcare (Covington, KY)
- …closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and ... and clinical leadership for health plan and/or market specific utilization management and care management ...health portions of state contracts. * Assists behavioral health medical director lead trainers in the development… more
- Veterans Affairs, Veterans Health Administration (Florence, KY)
- Summary The Clinical Medical Director directly reports the Chief of Primary Care / ACOS and will be responsible for all aspects of medical care delivered to ... series. For more information, refer to Required Documents below. Responsibilities The Clinical Medical Director must be able to perform all services required in… more
- Elevance Health (Cincinnati, OH)
- ** Medical Director Associate - CarelonRx** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... dispensing services to drive affordability and improve member outcomes. The ** Medical Director Associate- CarelonRx** supports pharmacy prior authorization… more
- Molina Healthcare (Covington, KY)
- …with operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process ... early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies...+ Research and develop reports and analysis for senior management , effectively presenting and communicating results. + Works closely… more
- Molina Healthcare (Covington, KY)
- …+ Manage projects spanning multiple domains + Supports Market and Enterprise management and other team members are related to all things financially related ... reserves for appropriateness monthly + Work collaboratively with Actuarial and Medical Economics partners to evaluate correlation among various parameters impacting… more
- Molina Healthcare (Covington, KY)
- …need. * Offers a positive leadership role in key segment/product medical management initiatives aimed a optimizing utilization of medical resources. * ... and at least 2 years as a medical director in managed care organization supporting utilization management /quality program management , or equivalent… more
- CenterWell (Fort Mitchell, KY)
- …of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. + ... objectively, in consultation with the Human Resources Department and the Executive Director / Director of Operations. + Participates in the interviewing, hiring,… more
- City of Cincinnati (Cincinnati, OH)
- …studies and surveys with technical staff; for the purpose of quality assurance, utilization review and the overall improvement of medical programs of the ... Benefits + Questions General Statement of Duties This employee perform professional medical work relating to the evaluation and treatment of newborns, infants,… more
- ChenMed (Cincinnati, OH)
- …with other health care professionals. Consults with the manager, physician, and medical director to ensure compliance with guidelines. This position may ... team and is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and home settings… more
- Radial (Walton, KY)
- …a new or existing building and associates. + Work closely in partnership with the Site Director + Work closely with the TA and Staffing Team to serve as a point of ... contact for seasonal staffing management for the site. + Will serve as generalist...strategic and business-aligned HR model. + Facilitate HR Central utilization and employee interaction, reporting and investigation processes. +… more