Utilization Manager Jobs in Columbus, OH (NOW HIRING)

Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations ...

For billing and hospitalization utilization review purposes, the reviewer will identify and certify ... Maintain compliancy with regulation changes affecting utilization management. PositionRequirements ...

Conducts utilization reviews of behavioral health cases to determine medical necessity ... Assists with retrospective reviews and denial management to maintain appropriate and cost-effective ...

Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...

Participates as an active management member of the Mount Carmel Health Plan representing the Utilization Review Department in collaboratively meeting operational, budget, and strategic planning goals ...

Job Title: Clinical Financial Case Mgr - RN Department: Health System Shared Services | Revenue ... The job duties require the utilization of clinical knowledge to interpret and apply medical ...

Care Review Clinician Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at ...

... with utilization management and care coordination team. 5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

LCDC III or LSW is acceptable if working in the Substance Abuse Program.  Prefer 2 years utilization review, discharge planning, case management or medical social work experience.  Strong ...

Directing all activities in a clinical focused area of expertise (Utilization Management (UM) or Quality Improvement) to ensure alignment with the department's population health strategies, health ...

Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...

Working with patients ranging from newborn through geriatric populations, this role integrates clinical case management, utilization management, discharge planning, psychosocial assessment ...