... and 30% remote. The patient members that they will be assessing are dual eligible Medicare ... staff, utilization management staff, health plan partners and contracted providers. RN Field ...
... and 30% remote. The patient members that they will be assessing are dual eligible Medicare ... staff, utilization management staff, health plan partners and contracted providers. RN Field ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development. * Lead cross ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development. * Lead cross ...
Identifying and forwarding standard or expedited appeals to the appropriate health plan. * Staying current on industry regulations, guidelines, and best practices related to utilization management ...
Identifying and forwarding standard or expedited appeals to the appropriate health plan. * Staying current on industry regulations, guidelines, and best practices related to utilization management ...
Director, Trade Client Relations
New Hampshire, OH · On-site +1
$155K - $175K/yr
... in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
Director, Trade Client Relations
New Hampshire, OH · On-site +1
$155K - $175K/yr
... in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
Director, Trade Client Relations
Delaware, OH · On-site +1
$155K - $175K/yr
... in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
Director, Trade Client Relations
Delaware, OH · On-site +1
$155K - $175K/yr
... in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
Medical Director(Neonatologist Preferred)
Dayton, OH · On-site +1
$195K - $341K/yr
Essential Functions: * Work directly with Vice Presidents of Utilization Management, Care ... Work with market leaders to be a liaison to community based organization and health systems ...
Medical Director(Neonatologist Preferred)
Dayton, OH · On-site +1
$195K - $341K/yr
Essential Functions: * Work directly with Vice Presidents of Utilization Management, Care ... Work with market leaders to be a liaison to community based organization and health systems ...
Clinical Financial Case Mgr - RN
Columbus, OH · On-site +1
... Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines. The ... Location: Remote Location Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final ...
Clinical Financial Case Mgr - RN
Columbus, OH · On-site +1
... Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines. The ... Location: Remote Location Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final ...
... Remote US, UK, Ireland, Poland, Canada ICON is a global healthcare intelligence and clinical ... Exceptional commercial and financial acumen , including a deep understanding of utilization ...
... Remote US, UK, Ireland, Poland, Canada ICON is a global healthcare intelligence and clinical ... Exceptional commercial and financial acumen , including a deep understanding of utilization ...
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... health management when appropriate. Maintain a working knowledge of all Quantum Health workflows.
New
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... health management when appropriate. Maintain a working knowledge of all Quantum Health workflows.
New
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... health management when appropriate. Maintain a working knowledge of all Quantum Health workflows.
New
Quick apply
Fully remote if live >50 miles from Dublin campus What you'll do (Essential Responsibilities ... health management when appropriate. Maintain a working knowledge of all Quantum Health workflows.
New
* Remote States: Ohio, North Carolina, South Carolina, Georgia, Tennessee and Florida PURPOSE OF THIS ... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ...
* Remote States: Ohio, North Carolina, South Carolina, Georgia, Tennessee and Florida PURPOSE OF THIS ... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ...
Healthcare Data Analyst (Remote)
Findlay, OH · On-site +1
* Remote States: Ohio, North Carolina, South Carolina, Georgia, Tennessee and Florida PURPOSE OF THIS ... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ...
Healthcare Data Analyst (Remote)
Findlay, OH · On-site +1
* Remote States: Ohio, North Carolina, South Carolina, Georgia, Tennessee and Florida PURPOSE OF THIS ... Managers throughout BVHS to research and analyze relevant clinical, utilization, cost, and program ...
Operations Manager - Cincinnati, Ohio
Cincinnati, OH · On-site +1
... remote or distributed operational teams is preferred * Strong negotiation, communication, and partner management skills * Ability to analyze performance data and drive continuous improvement
Operations Manager - Cincinnati, Ohio
Cincinnati, OH · On-site +1
... remote or distributed operational teams is preferred * Strong negotiation, communication, and partner management skills * Ability to analyze performance data and drive continuous improvement
Acquisition Utilization Specialist
Cincinnati, OH · On-site +1
$77K - $101K/yr
... and healthcare services, product acquisition and support services required by project managers ... Acquisition Utilization Specialist/ PD99810S Physical Requirements: Work is primarily sedentary in ...
Acquisition Utilization Specialist
Cincinnati, OH · On-site +1
$77K - $101K/yr
... and healthcare services, product acquisition and support services required by project managers ... Acquisition Utilization Specialist/ PD99810S Physical Requirements: Work is primarily sedentary in ...
Corporate Counsel
Dublin, OH · Remote
... utilization management programs, wellness program incentive management, claim and appeal ... Health's values, ethics, and data privacy requirements. -- #LI-AT1 #LI-Remote
Quick apply
Corporate Counsel
Dublin, OH · Remote
... utilization management programs, wellness program incentive management, claim and appeal ... Health's values, ethics, and data privacy requirements. -- #LI-AT1 #LI-Remote
Corporate Counsel
Dublin, OH · Remote
... utilization management programs, wellness program incentive management, claim and appeal ... Health's values, ethics, and data privacy requirements. -- #LI-AT1 #LI-Remote
Corporate Counsel
Dublin, OH · Remote
... utilization management programs, wellness program incentive management, claim and appeal ... Health's values, ethics, and data privacy requirements. -- #LI-AT1 #LI-Remote
Sr. Product Manager, Edge Infrastructure Solutions
Westerville, OH · On-site +1
$121K - $161K/yr
This role focuses on integrating racks, power distribution, UPS, thermal management, and remote ... health, without discrimination as to age, race, color, religion, creed, sex, pregnancy status ...
Sr. Product Manager, Edge Infrastructure Solutions
Westerville, OH · On-site +1
$121K - $161K/yr
This role focuses on integrating racks, power distribution, UPS, thermal management, and remote ... health, without discrimination as to age, race, color, religion, creed, sex, pregnancy status ...
IHBT Program Manager
Coshocton, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
Quick apply
IHBT Program Manager
Coshocton, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
IHBT Program Manager
Coshocton, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
IHBT Program Manager
Coshocton, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
IHBT Program Manager
Columbus, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
Quick apply
IHBT Program Manager
Columbus, OH · Remote
$73K - $93K/yr
Oversee documentation audits, utilization management, and billing integrity * Maintain adherence to ... Utilizes databases and Electronic Health Record systems for accurate client documentation
Cvs Health Utilization Management Remote information
What is the difference between Cvs Health Utilization Management Remote vs Cvs Health Medical Reviewer?
| Aspect | Cvs Health Utilization Management Remote | Cvs Health Medical Reviewer |
|---|---|---|
| Credentials | RN, LPN, or other healthcare licenses | RN, MD, or DO licenses |
| Work Environment | Remote, home-based | Remote or onsite, depending on role |
| Employer & Industry Usage | Utilization management for insurance approvals | Medical review for claims and authorizations |
Both roles involve healthcare assessments, often requiring similar licenses. Utilization Management Remote focuses on reviewing medical necessity for insurance purposes, while Medical Reviewers may handle detailed case evaluations. Both are remote-friendly and integral to healthcare insurance processes, but differ slightly in scope and responsibilities.
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For Cvs Health Utilization Management Remote jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Cvs Health Utilization Management Remote jobs in Ohio look for?
The top searched job categories for Cvs Health Utilization Management Remote jobs in Ohio are:
What cities in Ohio are hiring for Cvs Health Utilization Management Remote jobs?
Cities in Ohio with the most Cvs Health Utilization Management Remote job openings:
RN Field Behavioral Health Case Manager
Maumee, OH • Remote
Healthcare Support Staffing •
Recruiting and Staffing Services • 201 - 500 employees201 - 500 employees
Full-time
Re-posted 8 days ago
Job description
Company Description
Are you an experienced Administrative Assistant looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!
Job Description
RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. RN Field Behavioral Health Case Manager assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the High Risk Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.
Daily Responsibilities:
RN Field Behavioral Health Case Manager will be responsible for the Lucas County patient members'
Work telephonically with patients identified as high risk to identify needs, set goals and implement action steps towards achieving goals.
Empower patients to help them improve their quality of life.
Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.
RN Field Behavioral Health Case Manager participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.
RN Field Behavioral Health Case Manager will assist with the implementation of policies and procedures regarding case management and utilization management functions.
Working with these members to identify needs and goals to achieve improved quality of life.
Maintain HIPAA compliance.
Qualifications
Requirements:
MUST have a valid RN License in the State of OH
3 years of Behavioral Health experience
3-5 years of case and/or utilization management experience.
CCM (Certified Case Manager) or other clinical certification preferred
Hours for this Position:
Monday - Friday 8 am - 5 pm.
Advantages of this Opportunity:
Competitive salary
Growing Company
Medical benefits go into effect 30 days after start date
Additional Information
If you are interested in applying to this position, please contact Shanna Ramirez, (407) 636-7030 ext. 170 and click the Green "I'm Interested" Button to email your resume.
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003