Top 37 Utilization management Jobs in Fremont, Oh

Assistant Medical Director
Medical Mutual of Ohio —Ohio
- Remote
- Medicine
- 5 years
- Word processing
- Health savings account
- Disability insurance
Clinical Dietitian O/P: FT Salaried
Firelands Health —Sandusky, OH
- Full-time
- Mid-level
- Clinic
- Driver's License
- Health insurance
- Dental insurance
Quick Apply
Patient Access Associate Specialist
Ensemble RCM LLC —Sandusky, OH
- $17.00 - $18.15 an hour
- Part-time
- Acute care
- Hospital
- Customer service
- Tuition reimbursement
Care Plan Reviewer- OhioRISE
CVS Health —Ohio
- $60,522 - $129,615 a year
- Full-time
- LMFT
- Mid-level
- Outpatient experience
- Health insurance
- Dental insurance
5d
Behavioral Health Provider
Health Partners of Western Ohio —Tiffin, OH
- From $72,000 a year
- Full-time
- OSHA
- Computer literacy
- Primary Care
- Continuing education credits
- 403(b) matching
Quick Apply
Case Management/UR, RN
Magruder Hospital —Port Clinton, OH
- PRN
- Nursing
- RN License
- Hospital
- Opportunities for advancement
Quick Apply
Quality Process Coord/Discharge Planner: FT
The Bellevue Hospital —Bellevue, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
4d
Nursing Supervisor, FT
Magruder Hospital —Port Clinton, OH
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Health insurance
- Opportunities for advancement
Quick Apply
Nursing Supervisor - PRN
Magruder Hospital —Port Clinton, OH
- PRN
- Microsoft Word
- Nursing
- Microsoft Excel
- Health insurance
- Opportunities for advancement
Quick Apply
Occupational Therapist
Reliant Rehabilitation —Port Clinton, OH
- $55 - $60 an hour
- PRN
- English
- Mid-level
- Discharge planning
- Health insurance
- Dental insurance
Clinical Dietitian: PT 8a-4:30p
Firelands Health —Sandusky, OH
- Part-time
- Mid-level
- Clinic
- Driver's License
- Health insurance
- Dental insurance
Quick Apply
Physician Assistant/Nurse Practitioner (D), CVOR - Regional
Corewell Health —United States
- Weekends as needed
- Acute care
- Nursing
- Surgery
- Free parking
- Paid holidays
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Director, Network Performance
Sound Physicians —United States
- $110,000 - $140,000 a year
- Remote
- 6 years
- Bachelor's degree
- Critical & Intensive Care
- Paid holidays
- Health insurance
Quick Apply
7d
$5K Sign-on! Regional MyoPro® Orthotist/Prosthetist - CA
Myomo, Inc —United States
- $90,000 - $120,000 a year
- Full-time
- Microsoft Outlook
- 3 years
- Neurology
Quick Apply
Remote Psychologist - US Location
APN Staffing & Employment Solutions —United States
- $100,000 a year
- Full-time
- Remote
- Word processing
- Writing skills
- Mid-level
Quick Apply
12d

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Quality Process Coord/Discharge Planner: FT
The Bellevue Hospital —Bellevue, OH
Post hospitalization phone calls and intervention s appropriate. Collaborate with interdisciplinary care teams to develop individualized discharge plans based…
Quick Apply
4d
Home Health Registered Nurse 13 Week Contract
Direct Medical Staffing —Lorain, OH
Proven clinical experience in hospital medicine or outpatient settings with a focus on acute care or post-acute care environments.
$2,050 - $2,150 a week
Quick Apply
2h

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Infection Prevention Staff Development IPSD
Majestic Care of Whitehall —Whitehall, OH
Current LPN or RN license by State Board of Nursing in state employed; license must be active, valid, and in good standing.
Quick Apply
VRCC Director, Business Office
SUN Behavioral Health —Columbus, OH
Effectively utilizes and understands the departmental computer system to realize its optimal potential and to be able to evaluate and answer staff member…

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utilization management jobs near fremont, oh

Assistant Medical Director

Medical Mutual of Ohio -
Ohio

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Job Details

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Gym membership

Qualifications

BC/BE
Patient care

Full Job Description

**Medical Mutual employees must submit their applications through MySource.

**This is a remote-based role, and we are currently seeking candidates located in Ohio.

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 high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Provides clinical expertise to promote the delivery of high quality, cost effective, (member centric) medical care. Contributes to the achievement of clinical excellence; quality ratings improvement, appropriate inpatient and outpatient utilization, affordability, compliance, growth and focused improvement, and that initiatives are consistently implemented and successfully executed to achieve goals.

Responsibilities:

Provides clinical expertise to the utilization review process and determinations.
Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise.
Ensures compliance with clinical goals through monitoring of care management performance.
Ensures the appropriate and most cost-effective medical care is received.
Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
Provides guidance to case management team in the coordination of quality care.
Performs other duties as assigned.

Qualifications:

Education and Experience:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school.
Minimum of 5 years of established (clinical) care practice experience required.
Physician reviewer experience in the insurance industry preferred.

Professional Certification(s):

Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
Active unrestricted license to practice medicine in U.S state of residency.

Technical Skills and Knowledge:

Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
Strong understanding of integration of evidence-based medicine and managed care principles.
Knowledge of health plan claims adjudication and utilization review processes preferred.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.

Excellent Benefits and Compensation:

Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-CS1 #LI-REMOTE

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

utilization management jobs in fremont, oh

Assistant Medical Director

Clinical Dietitian O/P: FT Salaried

Patient Access Associate Specialist

Care Plan Reviewer- OhioRISE

Behavioral Health Provider

Case Management/UR, RN

Quality Process Coord/Discharge Planner: FT

Nursing Supervisor, FT

Nursing Supervisor - PRN

Occupational Therapist

Clinical Dietitian: PT 8a-4:30p

Physician Assistant/Nurse Practitioner (D), CVOR - Regional

Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)

Director, Network Performance

$5K Sign-on! Regional MyoPro® Orthotist/Prosthetist - CA

Remote Psychologist - US Location

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