11 Medical Director And Reviewer Positions jobs in Cincinnati.

Hiring now: Care Review Clinician Inp @ Molina Hea, Independent Medical Exam @ Dane Stree, Dermatopathologist Amp @ Quest Diag, Nurse Reviewer I @ Elevance H, Provider Reimburse Admin @ Elevation .Explore more at jobswithgpt.com.

šŸ”„ Skills

cost-effective (2) financial responsibility (2) prior authorization (2) medical records (2) clinical guidelines (2) utilization management (2) inpatient reviews (1) clinical service requests (1) evidence-based clinical guidelines (1) medically appropriate care (1)

šŸ“ Locations

Covington (5) Cincinnati (4) Mason (2)
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Molina Healthcare

Care Review Clinician, Inpatient Review (RN) Covington
Skills & Focus: inpatient reviews, clinical service requests, evidence-based clinical guidelines, medically appropriate care, cost-effective, financial responsibility, prior authorization, multidisciplinary team collaboration, Utilization Management Certification, hospital acute care
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: 3+ years hospital acute care/medical experience.
Salary: $23.76 - $51.49 / HOURLY
Benefits: Molina Healthcare offers a competitive benefits and compensation package.
Specialist, Appeals & Grievances Covington
Skills & Focus: appeals, grievances, member complaints, provider complaints, research, resolution, medical records, claims processing, communication, regulatory guidelines
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: Min. 2 years operational managed care experience (call center, appeals or claims environment).
Salary: $21.16 - $38.37 / HOURLY
Type: Full Time
Benefits: Molina Healthcare offers a competitive benefits and compensation package.
Care Review Clinician, Inpatient Review (RN) Covington
Skills & Focus: inpatient services, clinical guidelines, financial responsibility, prior authorization, multidisciplinary teams, quality care, cost effectiveness, state and federal regulations, eligibility, long term care
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: 3+ years hospital acute care/medical experience
Salary: $26.41 - $51.49 / HOURLY
Benefits: Molina Healthcare offers a competitive benefits and compensation package.

Dane Street

Independent Medical Exam Reviewer Covington
Skills & Focus: Independent Medical Exams, veteran community, schedule flexibility, block time commitments, advisory-only opinions, physician advisor services, case flow, web-based portal, training provided, 1099 contract reviewers
About the Company: Dane Street is an Independent Review Organization and a national provider of Independent Medical Exams (IMEs), expanding its physician panel to support veteranā€¦
Experience: Active state licensure required.
Type: Contract
Benefits: Schedule flexibility and predictable work hours, robust opportunity for consistent additional income, thorough orientatā€¦

Molina Healthcare

Care Review Clinician, Inpatient Review (RN) Covington
Skills & Focus: inpatient, review, clinical guidelines, authorization, utilization management, collaboration, multidisciplinary, cost-effective, treatments, encounter
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are sā€¦
Experience: 3+ years hospital acute care/medical experience.
Salary: $23.76 - $51.49 / HOURLY
Type: Full-time
Benefits: Molina Healthcare offers a competitive benefits and compensation package.

Quest Diagnostics

Dermatopathologist - AMP Cincinnati
Skills & Focus: Dermatopathologist, Medical, DO Degree, board certified, pathology, diagnosis, team player, customer focus, healthcare, Cincinnati
About the Company: Dermpath Diagnostics, a fully owned subsidiary of Quest Diagnostics, focuses on providing exceptional Dermatopathology services with a team of over 70 board-ceā€¦
Experience: 1 to 3 years preferred; fellows will be considered
Type: Full-Time
Benefits: Comprehensive and competitive benefits package which includes paid time off, Medical, Dental, Prescription, Vision, Lifā€¦

Elevance Health

Nurse Reviewer I Cincinnati
Skills & Focus: medical necessity, clinical screening, diagnostic imaging, preauthorization, managed healthcare, utilization management, RN license, patient care, quality management, healthcare providers
About the Company: Elevance Health is a health company dedicated to improving lives and communities ā€“ and making healthcare simpler. We are a Fortune 25 company with a longstandiā€¦
Experience: Minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience.
Salary: $34.69/hr to $54.41/hr
Type: Full-time
Benefits: Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401k contribution, paid holiā€¦
Oncology Medical Director- Commercial National Division Cincinnati
Skills & Focus: oncology, medical director, clinical consultation, case management, utilization review, evidence-based guidelines, health care quality, cost-effective medical care, peer-to-peer clinical reviews, program implementation
About the Company: Elevance Health is a health company dedicated to improving lives and communities ā€“ and making healthcare simpler. We are a Fortune 25 company with a longstandiā€¦
Experience: Minimum of 10 years of clinical experience
Salary: $262,152 to $398,228
Type: Full-time
Benefits: comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution
Behavioral Health Medical Director- Psychiatrist Cincinnati
Skills & Focus: Behavioral Health, Medical Director, Psychiatrist, Clinical reviews, Health care quality, Peer clinical reviews, Medical necessity reviews, Policy interpretation, Healthcare operations, Board certification
About the Company: Elevance Health is a health company dedicated to improving lives and communities ā€“ and making healthcare simpler. We are a Fortune 25 company with a longstandiā€¦
Experience: Minimum of 10 years of clinical experience
Type: Hybrid
Benefits: Medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, ā€¦

Elevation Health

Provider Reimburse Admin Sr Mason
Skills & Focus: reimbursement policies, claims adjudication, subject matter expert, medical policies, editing policies, vendor collaboration, business process improvements, provider reimbursement activities, mentorship, coding conventions
About the Company: Elevation Health is a health company dedicated to improving lives and communities ā€“ and making healthcare simpler. We are a Fortune 25 company with a longstandā€¦
Experience: 4 years related experience; or any combination of education and experience.
Salary: $76,296 to $124,848
Type: Hybrid (1-2 days in the office)
Benefits: comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution