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Cvs Health Utilization Management Remote Jobs in Ohio

Valeris

Executive Case Manager (Remote)

Cincinnati, OH · Remote

Minimum two years of experience in healthcare access delivery or management is strongly preferred ... Remote work eligibility is subject to all work from home criteria met and based on business need ...

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Cvs Health Utilization Management Remote information

What is the difference between Cvs Health Utilization Management Remote vs Cvs Health Medical Reviewer?

AspectCvs Health Utilization Management RemoteCvs Health Medical Reviewer
CredentialsRN, LPN, or other healthcare licensesRN, MD, or DO licenses
Work EnvironmentRemote, home-basedRemote or onsite, depending on role
Employer & Industry UsageUtilization management for insurance approvalsMedical 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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Cvs Health Utilization Management Remote jobs near you

Optometrist - Remote

Health Partners of Western Ohio

Columbus, OH • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 17 days ago

Job description

Optometrist (Remote) - School Based Outreach
This is a full-time position following the assigned school districts school year and paid all year round.
(Monday through Friday 7:30am - 4:00pm)
The school year includes all working days for teachers, including remote work days, and is subject to potential modifications throughout the school year.
POSITION PURPOSE
The Optometrist is primarily responsible for examining the eyes and other parts of the visual system. In addition, the Optometrist will also diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes. The Optometrist will also prescribe eyeglasses or contact lenses as needed. The Optometrist will promote eye health and counsel patients on how general health can affect eyesight. Position can be located remote or hybrid.
QUALIFICATIONS
EDUCATION/CERTIFICATION: Must complete a Doctor of Optometry (O.D.) degree program from an accredited optometry school and complete all sections of the National Board of Examiners in Optometry exam. Current license to practice as a Doctor of Optometry (O.D.).
REQUIRED KNOWLEDGE: Successful completion of in-house training.
EXPERIENCE REQUIRED: Minimum of 5 years as a practicing Doctor of Optometry (O.D).
BENEFITS:
  • Paid Time Off (PTO)
  • Insurance (Medical, Dental, and Vision)
  • Paid Holidays
  • 403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
  • Eligible to Apply for National Health Service Corps Loan Repayment
  • Continuing Education Money ($3,000) that can be used for license, DEA, memberships, CE classes and travel expenses.
  • Annual Raises
  • Training Opportunities

ESSENTIAL FUNCTIONS AND BASIC DUTIES:
  • Assist with establishing vision policies, quality improvement procedures, and evaluating current practices, policies, and procedures.
  • Staying abreast of changing healthcare landscape and opportunities for utilization of technologies to support the enhanced provision of vision services for patients.
  • Maintain supervision and communication with optical and support staff to optimize quality clinical care and services.
  • Provides leadership in developing the vision care plan and review of the program requirements; and recommends changes when necessary to carry out the vision plan as required.
  • Assist the Clinical Director in designing, implementing, and evaluating educational programs for the Health Partners of Western Ohio patients and vision staff.
  • Assume quality care for all patients.
  • Complete patient history and conduct eye examinations using optometric equipment and general diagnostic interpretation.
  • Diagnose sight problems, such as nearsightedness or farsightedness, and eye diseases, such as glaucoma.
  • Prescribe eyeglasses, contact lenses, and other visual aids, and if state law permits, medications.
  • Provide treatments such as vision therapy or low-vision rehabilitation.
  • Evaluate patients for the presence of other diseases and conditions, such as diabetes or hypertension, and refer patients to other healthcare providers as needed.
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Utilize supplies cost-effectively while ensuring that the vision department stays within budget.
  • Participate in continuing education and professional growth.
  • Maintain knowledge of, and complies with, personnel and Vision policies and procedures.
  • Adhere to the standards and policies of the Organizational Privacy/ Security and Compliance Programs, including the duty to comply with applicable laws and regulations (HIPAA, OSHA, OIG guidelines, and other State and Federal laws).
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Provide services in office and throughout community in an outreach manner.
  • May be responsible for driving HPWO vehicle to provide services.
  • Employee is to follow all policies and procedures regarding company vehicle.
  • The position is responsible for other duties as assigned.

WORK ENVIRONMENT
Work is primarily sedentary, demanding sitting, walking, lifting, and bending. Those physical movements and the degree of mobility, manual dexterity, and hand-eye coordination commonly associated with duties in an office setting will be performed repetitively. This also includes bending, twisting, reaching, lifting, pulling, pushing, and walking. The ability to distinguish letters and symbols and utilize telephones, computer terminals, fax machines, and copiers is required. The work environment characteristics described here represent those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. Working under stressful conditions, as well as irregular hours, may be required.

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