Top 129 Quality liaison Jobs in Circleville, Oh

Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
Quick Apply
21st Century Site Director United Schools Network
YWCA Columbus —Columbus, OH
- $52,000 - $54,000 a year
- Full-time
- School experience
- Classroom
- Customer service
- Health savings account
- Health insurance
Quick Apply
2d
Supplier Quality Engineer
MS Companies —Canal Winchester, OH
- $88,000 a year
- Full-time
- Up to 50% travel
- Engineering
- Mid-level
- Opportunities for advancement
Quick Apply
12d
Assistance Maintenance Manager
ReOpOhio LLC (Real Estate Opportunity) —Columbus, OH
- $55,000 - $65,000 a year
- Full-time
- Mid-level
- Driver's License
- Data entry
- Dental insurance
- 401(k)
Quick Apply
10d
Employee Relations Specialist
Woda Cooper —Columbus, OH
- Full-time
- Background check
- Pass drug screening
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
PCA- 3B Observation (Days) FT
Adena Health System —Chillicothe, OH
- Full-time
- Word processing
- High school diploma or GED
- Telemetry
- Health insurance
- Tuition reimbursement
1d
Security Shift Supervisor - Customer Service
Allied Universal —Ashville, OH
- $23 an hour
- Full-time
- 18 years or older
- Clean driving record
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Patient Care Technician - PCT
Fresenius Medical Care —Circleville, OH
- Full-time
- Inventory control
- Heavy lifting
- Laboratory experience
2d
Encounter Data Liaison (Medicaid Health Systems Administrator 2)
State of Ohio - Medicaid —Columbus, OH
- $44.38 an hour
- Full-time
- Mid-level
- Driver's License
- Travel
- Paid holidays
- Health insurance
8d
Quality Outreach Coordinator - PFK Clinical Integration
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Ability to climb stairs
- Driver's License
- Bachelor's degree
Housing Coordinator
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Mid-level
- 3 years
- Master's degree
Patient Care Associate (PCA) - 2NE Cardiovascular PCU (Days) FT
Adena Health System —Chillicothe, OH
- Full-time
- High school diploma or GED
- Telemetry
- Cardiology
- Health insurance
- Tuition reimbursement
14d
Case Manager
Lighthouse Youth & Family Services —Chillicothe, OH
- $20.19 - $29.10 an hour
- Mid-level
- Outpatient experience
- Outpatient
8d
Safety Manager
DSV —Lockbourne, OH
- $95,000 - $105,000 a year
- Email
- Team management
- Senior level
- Leadership
10d
PCA- 3B Observation (Days) PT
Adena Health System —Chillicothe, OH
- Part-time
- Word processing
- High school diploma or GED
- Telemetry
- Health insurance
- Tuition reimbursement
6d
Student Information Specialist
Capital University —Columbus, OH
- Full-time
- Mid-level
- Office
- University
- Free parking
- Disability insurance
Quick Apply
Lead Inventory Associate - 3rd shift (10:00 PM-6:30 AM)
DSV —Canal Winchester, OH
- $27 an hour
- Full-time
- Local
- Mid-level
- Forklift
PCA- 3B Observation (Nights) FT
Adena Health System —Chillicothe, OH
- Full-time
- Hospital
- Word processing
- High school diploma or GED
- Health insurance
- Tuition reimbursement
1d
Medical Staff Peer Review Coordinator
FAIRFIELD MEDICAL CENTER —Lancaster, OH
- $26.57 - $43.76 an hour
- Full-time
- Nursing
- RN License
- Hospital
Chaplain, Associate (Part-time/ Casual)
OhioHealth —Pickerington, OH
- Part-time
- Acute care
- Hospital
- Inpatient

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Utilization Management Specialist

ST VINCENT FAMILY SERVICES
Columbus, OH

Quick Apply

Job Details

Full-time

Benefits

Paid time off
401(k) matching

Qualifications

Associate's degree

Full Job Description

At St. Vincent Family Services, it's our job to help families build bright futures. Make it your job, too!

We offer competitive compensation based on education, experience, licensure, and internal equity, along with comprehensive benefits, 401(k) matching, and a generous PTO package.

These are just a few of the many reasons to join our team.

SUMMARY

The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs). This position serves as the primary liaison between St. Vincent Family Services and MCO payors to ensure authorization requests are submitted timely, approved services are tracked accurately, and service disruptions are prevented.

The Utilization Management Specialist monitors client eligibility, tracks authorized units by procedure code, manages authorization renewals, and communicates authorization approvals and denials to treatment teams. This role works closely with clinical staff, program leadership, billing, and MCO representatives to maximize reimbursement, ensure compliance with payer requirements, and support continuity of care for clients.

ESSENTIAL DUTIES & RESPONSIBILITIES

Maintains confidentiality and compliance with HIPAA, agency policies, and payer regulations.
Serves as the primary point of contact for all MCO prior authorization activities.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals, denials, and requests for additional information.
Verifies and documents client eligibility and insurance coverage prior to authorization submission and throughout treatment episodes.
Runs authorization utilization reports and analyzes data to identify clients approaching authorization thresholds.
Maintains an authorization tracking system that includes:
- Authorization numbers
- Approved dates of service
- Procedure codes
- Authorized units
- Units utilized
- Remaining units
- Expiration dates
Monitors service utilization and proactively identify clients nearing authorized unit limits.
Requests completed clinical documentation and authorization forms from treatment providers when renewal thresholds are met.
Reviews authorization packets for completeness and accuracy prior to MCO submission.
Submits initial, concurrent, and reauthorization requests to Medicaid Managed Care Organizations within required timelines.
Coordinates responses to MCO requests for additional documentation or clinical information.
Communicates authorization approvals, denials, partial approvals, and service changes to treatment team members in a timely manner.
Collaborates with program directors, treatment providers, and billing staff to resolve authorization concerns and prevent service interruptions.
Maintains organized electronic records of all authorization submissions, determinations, and correspondence.
Tracks authorization denial patterns and communicates trends to leadership.
Assists with audits, quality assurance activities, and compliance reviews related to authorization management.
Develops and maintains productive working relationships with MCO representatives.
Participates in department meetings, training, and process improvement initiatives.
Performs other duties as assigned.

QUALIFICATIONS

Education and/or Experience:

Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Minimum of two years of experience in healthcare authorization management, utilization management, medical billing, behavioral health administration, or related healthcare setting preferred.

Knowledge, Skills & Abilities:

Strong understanding of behavioral health authorization processes and payer requirements.
Knowledge of Medicaid and Managed Care authorization procedures preferred.
Excellent organizational skills and attention to detail.
Strong analytical skills and ability to interpret utilization and authorization reports.
Ability to manage multiple deadlines and competing priorities.
Ability to communicate effectively with clinical, administrative, and payer representatives.
Ability to maintain accurate records and follow complex payer requirements.
Ability to work independently while functioning as part of a collaborative team.

Technical Skills

Proficiency in Microsoft Outlook, Excel, Word, and Teams.
Ability to learn and navigate multiple MCO portals.
Experience with electronic health records and data management systems.
Ability to generate, analyze, and maintain utilization tracking reports.

WORK ENVIRONMENT

Standard office environment with occasional evenings/weekends for events. Hybrid schedule available after 90-day probationary period.

Requires prolonged sitting and extensive computer use.
Requires manual dexterity sufficient to operate a computer, telephone, and other office equipment.
Requires normal range of hearing and vision to prepare reports and communicate effectively.
May occasionally lift and/or move items up to 15 pounds.

Quick Apply

Refine Your Search

quality liaison jobs in circleville, oh

Utilization Management Specialist

21st Century Site Director United Schools Network

Supplier Quality Engineer

Assistance Maintenance Manager

Employee Relations Specialist

PCA- 3B Observation (Days) FT

Security Shift Supervisor - Customer Service

Patient Care Technician - PCT

Encounter Data Liaison (Medicaid Health Systems Administrator 2)

Quality Outreach Coordinator - PFK Clinical Integration

Housing Coordinator

Patient Care Associate (PCA) - 2NE Cardiovascular PCU (Days) FT

Case Manager

Safety Manager

PCA- 3B Observation (Days) PT

Student Information Specialist

Lead Inventory Associate - 3rd shift (10:00 PM-6:30 AM)

PCA- 3B Observation (Nights) FT

Medical Staff Peer Review Coordinator

Chaplain, Associate (Part-time/ Casual)

I want to receive the latest job alert for quality liaison in circleville, oh

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