- CVS Health (Columbus, OH)
- …**Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of the ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… 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
- Guardian Life (Columbus, OH)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- Highmark Health (Columbus, OH)
- …+ Deep Clincal Expertise -extensive knowledge of clinical , quality, care, utilization , high-cost claim, and population health management . Must be a ... Description :** **JOB SUMMARY** This job serves as the sales team's clinical expert, providing high-level support and insights for strategic clients, aligning… more
- Cardinal Health (Columbus, OH)
- **_What Specialty Networks (UroGPO) contributes to Cardinal Health_** _UroGPO_ creates clinical , operational & economic value for independent Community based Urology ... Networks in creating value to the members in their clinical , operational, and economical goals. This individual will be...Research, SONAR, PSMA Pet/CT, RLT' s and Chronic Care Management . This individual will lead these initiatives within their… more
- Molina Healthcare (Columbus, OH)
- …the results to senior leadership. Responsible for consulting with network and clinical management on opportunities to improve our company's discount position ... analysis of markets and network initiatives. The Medical Economics Consultant manages conflicting priorities and multiple projects concurrently. Responsible for… more
- Lincoln Financial (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for ... claims. In this role you will act as a clinical resource for Group Protection benefit specialists and claim...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- CenterWell (Columbus, OH)
- …and programs and will be charged to appropriately balance how we mitigate utilization management administrative costs while maintaining or decreasing drug spend ... Guide (NFG). This individual influences the department's strategy for optimizing the utilization management process in balance with mitigating drug … more
- CenterWell (Columbus, OH)
- … Clinical Pharmacist develops, maintains, and/or operationalizes strategies related to utilization management edits and/or clinical coverage policies for ... provide clinical support across Humana** **Conducts analysis on drug utilization trends to evaluate and inform formulary strategies.** **Collaborates on research… more
- ChenMed (Columbus, OH)
- …rapidly expanding and we need great people to join our team. The Clinical Pharmacist specializing in Population Health is a skilled and proactive professional who ... needed. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Acts as a national pharmacy consultant for our physicians regarding patient case inquiries, drug interactions,… more