50 utilization management opportunities in Oberlin updated today
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· Page 1 / 3Reporting to the Community Health Choices Market Chief Medical Officer, the CHC LTSS Medical Director provides medical leadership in the areas of LTSS utilization management and quality management to advance business objectives and improve the health and safety of our participant population. Work Ar
Company Description Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted e
**Medical Mutual employees must submit their applications through MySource. **This is a hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week. Founded in 1934, Medical Mutual is the oldest and one of the largest health
Medical Mutual employees must submit their applications through MySource. This is a hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week. Founded in 1934, Medical Mutual is the oldest and one of the largest health insu
Medical Mutual employees must submit their applications through MySource. This is a hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week. Founded in 1934, Medical Mutual is the oldest and one of the largest health insu
Role Overview Under the direction of the Utilization Management Operations Administrative Supervisor, the Utilization Management (UM) Correspondence Registered Nurse (RN) is responsible for creation, writing, editing and completion of all utilization management review adverse decision notices and an
HighmarkCompany Highmark Inc. Job Description JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Polic
We save lives while providing the opportunity for people to realize their healthy selves. Virtual Primary Therapist Monte Nido Eating Disorder Program Licensed in Oregon Monte Nido Virtual Program is an IOP/PHP program for adults seeking treatment for Anorexia Nervosa, Bulimia Nervosa, Binge Eating
About OncoHealth OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto R
About Intus Care: IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual workarounds with pu
Company Highmark Inc. Job Description JOB SUMMARY Weekend Remote RN - 3 days per week plus weekends. This job implements effective utilization management strategies including review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identi
HumanaBecome a part of our caring community The Formulary Operations Management Professional 2 provides clinical and operational leadership for build, maintenance, submission, and updating of formularies and drug lists. The Formulary Operations Management Professional 2 work assignments are varied and fre
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Care Manager RN in United States. This role offers an opportunity to make a meaningful impact on patient outcomes by combining clinical expertise with care coordination and data-driven decision-making
About Labela Labela is a community of doctors and life science experts helping push the frontier of AI. We work with leading AI teams to improve the quality, safety, and real-world usefulness of models across healthcare and science. Our experts contribute deep domain judgment to some of the most imp
Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to e
Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to e
Intermountain HealthJob Description: To plan, implement, coordinate, and manage care services to ensure safe and effective patient care. Scope Responsible for care management, and other related programs within an assigned Clinical Program, functioning with collaborative implementation and evaluation of Clinical Integra
OncoHealthAbout OncoHealth OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto R
*Location:** METROHEALTH MEDICAL CENTER *Biweekly Hours:** 00 *Shift:** Nights; Rotating Weekends and Holidays; Hybrid schedule after orientation (1 night on site, 2 nights at home) The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of commu
CoventBridge GroupOverview Experienced Investigative Clinician - Insurance Claims Remote Are you a licensed healthcare professional( RN or NP) with a passion for uncovering the truth behind medical claims? We’re seeking an experienced Investigative Clinician to join our team and support a major national client in eva
The MetroHealth SystemLocation: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: Nights; Rotating Weekends and Holidays; Hybrid schedule after orientation (1 night on site, 2 nights at home) The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community h
The MetroHealth System (Cleveland, OH)*Location:** METROHEALTH MEDICAL CENTER *Biweekly Hours:** 00 *Shift:** Nights; Rotating Weekends and Holidays; Hybrid schedule after orientation (1 night on site, 2 nights at home) The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of commu
**Medical Mutual employees must submit their applications through MySource. **This is a hybrid-remote role with employees expected to work onsite on designated in-office days each week. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We
Medical MutualDescription **Medical Mutual employees must submit their applications through MySource. **This is a hybridremote role with employees expected to work onsite on designated inoffice days each week. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in
Medical Mutual of Ohio**\*\*This is a hybrid‑remote role with employees expected to work onsite on designated in‑office days each week.*** Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our hi
Southwest General Health Center**POSITION INFORMATION** **Position summary:** The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriatenes
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resource
A healthcare organization is seeking a qualified RN Utilization Manager to work full-time in Middleburg Heights, OH. The role requires at least 5 years of recent clinical nursing experience, with a background in case and utilization management. Candidates should possess an unencumbered RN license in
We're on a path to better healthcare. Join us. Position : Director Utilization Management (Relocation Bonus Available) Compensation : $199,992 - $249,995.2 / year Department : Regional Office Location: Lemoyne, Pennsylvania (Onsite) You Matter Make a difference every day in the lives of the underser
$67,000 – $105,000/year
Estimation confidence: Low
Estimate based on market data for Oberlin. Actual salaries may vary depending on experience, company, and area.
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