- Elevance Health (Mason, 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
- Molina Healthcare (Cincinnati, OH)
- …, 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 (Cincinnati, OH)
- …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 (Cincinnati, OH)
- …, 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 (Cincinnati, OH)
- …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
- Elevance Health (Mason, OH)
- …schedule: Monday - Friday. Half day Saturday rotation, once a month.** The ** Medical Director ** is responsible for the administration of behavioral health ... increase effectiveness and quality. + Provides oversight, direction, and guidance to Medical Director Associates. + Works independently with oversight from… more
- Elevance Health (Mason, OH)
- …resides within a commutable distance from an office._** The **Business Strategy Plan Director - MedEx ( Medical Expense) Management ** is responsible for ... processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design… more
- Molina Healthcare (Cincinnati, OH)
- …+ 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
- Elevance Health (Cincinnati, OH)
- …behavioral health, long term services and supports, and psychosocial needs._ ** Medical Management Clinician** **Location:** This role enables associates to ... hours may be necessary based on company needs. The ** Medical Management Clinician** responsible for ensuring appropriate,... medical necessity denial determination made by a Medical Director . + May work directly with… 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
- Polaris Pharmacy Services, LLC (Lebanon, OH)
- …with the Administrator and/or Director of Nursing + Meet with the facility Medical Director and other key prescribers as warranted + Assists the facility to ... reports of these reviews, providing quarterly reports reflecting facility-level drug utilization and clinical management trends, recommendations to improve… 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