- CVS Health (Columbus, OH)
- …treatment/services. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, ... such as ambulatory care or outpatient clinic/facility. + Active and unrestricted Independent Behavioral Health clinical license in the state of Ohio. ( Ex… more
- CVS Health (Columbus, OH)
- …that empowers individuals to achieve better health outcomes. As a Behavioral Health Case Manager , you'll use your clinical expertise to support members ... Coordinate services across behavioral , physical, and psychosocial domains. + Apply clinical guidelines and case management best practices to ensure quality,… more
- CVS Health (Columbus, OH)
- …Interviewing and good technological skills + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations ... standard business hours. No weekends and no holidays.** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical… more
- OhioHealth (Columbus, OH)
- …for individuals from at-risk populations from interdisciplinary team members (including physicians, Case Managers, staff nurses and other members of the care team). ... responsibilities for scheduling staff, daily assigning of cases, and assisting the manager with direct supervision of the social work staff and masters level… more
- Molina Healthcare (Columbus, OH)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... to provide quality and cost-effective member care. Essential Job Duties * Provides behavioral health oversight and clinical leadership for health plan and/or… more
- Molina Healthcare (Columbus, OH)
- …License must be active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management certification ... or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other… more
- Molina Healthcare (Columbus, OH)
- …to navigate online portals and databases. Preferred Qualifications * Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), ... Required Qualifications * At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the… more
- Highmark Health (Columbus, OH)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case /utilization management and/or disease/condition management experience, or… more
- Elevance Health (Columbus, OH)
- …director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to account reporting ... medical policies used for operational reviews. + Leading multidisciplinary rounds for case management /complex clinical management. + Peer-to-peer outreach for… more
- Elevance Health (Columbus, OH)
- **LTSS Service Coordinator - Clinician ( Case Manager )** **Hiring near Columbus, OH** **Location** : This field-based role enables associates to primarily operate ... competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs.… more
- Elevance Health (Columbus, OH)
- …office visits with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering ... be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be responsible for developing and… more
- CenterWell (Columbus, OH)
- …and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal ... Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization… more
- Sharecare (Columbus, OH)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... A Disease Management Nurse is supervised by an Operations Manager (OM). All Sharecare clinicians are required to participate...during the training period will be evaluated on a case by case basis and must be… more
- Elevance Health (Columbus, OH)
- …competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs._ ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- Maxim Healthcare (Mount Vernon, OH)
- …changes in patient/client status to the Director of Clinical Services and/or Clinical Supervisor / Case Manager or licensed designee + Documents all ... medical record and + communicates this information as needed + Attends case conferences, team meetings, education in-services as required + Supports professional… more