- Elevance Health (Columbus, OH)
- …health, behavioral health, long term services and supports, and psychosocial needs._ ** Medical Management Clinician ** **Location:** This role enables ... hours may be necessary based on company needs. The ** Medical Management Clinician ** responsible for ensuring appropriate, consistent administration… 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 in ... term services and supports, and psychosocial needs. The **LTSS Service Coordinator- Clinician ** is responsible for working under the direction/supervision of an RN,… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for verifying ... with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... candidate must have a RN licensure and experience with medical surgical, emergency room, intensive care unit, or in...promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At… more
- Highmark Health (Columbus, OH)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of ... or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment and retrospective… more
- Datavant (Columbus, OH)
- …computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus. Minimum Education: LVN/LPN + ... utilization of available health services, review of admissions for medical necessity and necessity of continued stay in the...as it relates to job function as delegated by management Ideal candidate should be a Licensed Practical Nurse… more
- Centene Corporation (Columbus, OH)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for… more
- Molina Healthcare (Columbus, OH)
- …in Healthcare Management (CPHM). * Recent hospital experience in a medical unit or emergency room. Previous experience in managed care Prior Auth, Utilization ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner.… more
- Molina Healthcare (Columbus, OH)
- …* Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2 years… more
- Molina Healthcare (Columbus, OH)
- …Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.… more
- Molina Healthcare (Columbus, OH)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Nurse (RN). **Required Experience** 1-3 years of hospital or medical clinic experience. **Required License, Certification, Association** Active, unrestricted State… more
- Molina Healthcare (Columbus, OH)
- …* Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2 years… more
- CVS Health (Columbus, OH)
- …or at risk for involvement in, multiple child-serving systems. The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the ... case management process, in order to facilitate appropriate healthcare outcomes...activities and monitors care plan progress. * Enhancement of Medical Appropriateness and Quality of Care: o Using holistic… more
- ChenMed (Columbus, OH)
- …people to join our team. The Care Promoter 1 is an unlicensed medical professional cross-trained to perform routine administrative and clinical tasks to keep the ... medical centers running smoothly. The duties of Care Promoter...+ Catalogs and communicates patient needs to the PCP, Clinician , Specialist and/or other clinical personnel. + Prepares patients… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) ... Receive inbound and make outbound calls to eligible beneficiaries to schedule MTM clinician interventions in a manner that meets the specialized needs of the… more
- OptiMindHealth (Columbus, OH)
- …Work/life balance! Leadership and advancement opportunities! Join a leading clinician -led behavioral health company today! OptiMindHealth (OMH) is expanding and ... to our clinicians. Packages can be customized towards every clinician 's needs. Packages can include some combination of: ....can include some combination of: . Competitive Salary . Medical benefits . Paid malpractice policy . CEU reimbursement… more
- CVS Health (Columbus, OH)
- …departments. + Strong communication skills. + Strong organizational and time management skills. **Education** + Master's-level clinician and/or RN, licensed ... to coordinate, document, and communicate all aspects of the utilization/benefit management program. + Conduct clinical reviews for adult inpatient behavioral health… more
- CVS Health (Columbus, OH)
- …it all with heart, each and every day. **Program Summary:** Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible ... alternative contact information for members who are unreachable by care management . Employ motivational interviewing techniques to maximize member engagement and… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …medicine and/or clinical pharmacology and associated disciplines (eg biostatistics, data management , medical writing). + An advanced understanding of clinical ... disciplines, including immunology, biostatistics, clinical pharmacology, formulation science, data management , and medical writing. + Complete understanding of… more
- ChenMed (Columbus, OH)
- …people to join our team. The Care Promoter 1 is an unlicensed medical professional cross-trained to perform routine administrative and clinical tasks to keep the ... medical centers running smoothly. The duties of Care Promoter...+ Catalogs and communicates patient needs to the PCP, Clinician , Specialist and/or other clinical personnel. + Prepares patients… more