Current jobs related to Clinical Utilization Manager - Cincinnati, Ohio - Shaker for ChristianaCare Direct
-
Utilization Management Representative
4 weeks ago
Cincinnati, Ohio, United States Elevance Health Full timeJob Title: Utilization Management RepresentativeJob Summary:We are seeking a highly skilled Utilization Management Representative to join our team at Elevance Health. As a Utilization Management Representative, you will play a critical role in ensuring that our members receive the necessary healthcare services while minimizing unnecessary costs.Key...
-
Utilization Management Coordinator
4 weeks ago
Cincinnati, Ohio, United States Elevance Health Full timeJob Title: Utilization Management Representative ILocation:This role will work in a hybrid model, with a mix of remote and office work. Ideal candidates will live within 50 miles of one of our PulsePoint locations.Job Summary:The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization...
-
Cincinnati, Ohio, United States UC Health Full timeAbout the RoleThe Vice President of Utilization Management and Physician Advisor will play a critical role in driving clinical excellence and operational efficiency across UC Health. This senior leader will oversee the Physician Advisor Program, lead system-wide Clinical Documentation Improvement (CDI) initiatives, and work to optimize utilization management...
-
Facilities and Utilities Manager
2 weeks ago
Cincinnati, Ohio, United States Givaudan Full timeFacilities and Utilities SupervisorAt Givaudan, we're looking for a skilled Facilities and Utilities Supervisor to join our team. As a key member of our site operations, you'll be responsible for managing facility maintenance, overseeing external services, and leading a team of direct reports.Key Responsibilities:Manage facility maintenance, including...
-
Facilities and Utilities Manager
3 weeks ago
Cincinnati, Ohio, United States Givaudan Full timeFacilities and Utilities SupervisorAt Givaudan, we're committed to creating delightful taste and scent experiences that touch people's lives. As a Facilities and Utilities Supervisor, you'll play a critical role in ensuring the smooth operation of our site in Carthage, Cincinnati, OH.Key Responsibilities:Oversee facility maintenance, including equipment,...
-
Facilities and Utilities Manager
2 weeks ago
Cincinnati, Ohio, United States Givaudan Full timeFacilities and Utilities SupervisorAt Givaudan, we're looking for a skilled Facilities and Utilities Supervisor to join our team. As a key member of our site operations, you'll be responsible for managing facility maintenance, overseeing external services, and leading a team of direct reports.Key Responsibilities:Manage facility maintenance, including...
-
Facilities and Utilities Manager
3 weeks ago
Cincinnati, Ohio, United States Givaudan Full timeFacilities and Utilities SupervisorAt Givaudan, we're committed to delivering exceptional results and creating a positive impact on our customers and the environment. We're seeking a highly skilled Facilities and Utilities Supervisor to join our team at our Carthage site in Cincinnati, OH.Key Responsibilities:Oversee the maintenance and upkeep of our...
-
Utilization Management Representative I
2 weeks ago
Cincinnati, Ohio, United States Elevance Health Full timeJob Summary:Elevance Health is seeking a Utilization Management Representative I to join our team. In this role, you will be responsible for coordinating cases for precertification and prior authorization review.Key Responsibilities:Manage incoming calls and post-service claims work.Determine contract and benefit eligibility, and provide authorization for...
-
Clinical Research Coordinator
2 weeks ago
Cincinnati, Ohio, United States Velocity Clinical Research, Inc. Full timeClinical Research Coordinator Job SummaryVelocity Clinical Research, Inc. is seeking a highly skilled Clinical Research Coordinator to join our team. As a Clinical Research Coordinator, you will be responsible for managing clinical trials from start-up through study close-out in accordance with the study protocol, GCP, and Velocity's SOPs.Key...
-
Cincinnati, Ohio, United States UC Health Full timeJob SummaryUC Health is seeking a highly experienced and skilled Vice President of Utilization Management and Physician Advisor to lead our Physician Advisor Program and drive system-wide CDI initiatives. The ideal candidate will have a strong background in clinical operations, physician leadership, and utilization management.The successful candidate will...
-
Senior Clinical Research Coordinator
2 weeks ago
Cincinnati, Ohio, United States Velocity Clinical Research, Inc. Full timeJob SummaryVelocity Clinical Research, Inc. is seeking a highly skilled Clinical Research Coordinator to join our team. As a key member of our clinical research team, you will be responsible for conducting and managing clinical trials from start-up through study close-out in accordance with the study protocol, GCP, and Velocity's SOPs.Key...
-
Facilities & Utilities Site Manager
2 weeks ago
Cincinnati, Ohio, United States Givaudan Fragrances Full timeJob Title: Facilities & Utilities Site ManagerOverview:At Givaudan Fragrances, we are seeking a highly skilled Facilities & Utilities Site Manager to join our team in Cincinnati, OH. This role will be responsible for overseeing the facility maintenance of our Carthage site, ensuring the highest standards of safety, quality, and cost...
-
Utility Vegetation Auditor
2 weeks ago
Cincinnati, Ohio, United States ACRT, Inc. Full timeJob SummaryWe are seeking a highly skilled Utility Vegetation Auditor to join our team at ACRT, Inc. As a key member of our vegetation management team, you will be responsible for identifying, inspecting, and evaluating trees and brush along utility lines. Your expertise will help us ensure the safe and efficient operation of our clients' utility...
-
Clinical Trial Manager
1 month ago
Cincinnati, Ohio, United States Medpace Full timeClinical Trial Manager Job SummaryMedpace, a leading Contract Research Organization (CRO), is seeking an experienced Clinical Trial Manager to join our Clinical Trial Management Group in Cincinnati, OH. As a Clinical Trial Manager, you will be responsible for managing and providing accountability for day-to-day operations of clinical trials, ensuring...
-
Utility Vegetation Auditor
2 weeks ago
Cincinnati, Ohio, United States Acrt, Inc. Full timeJob Summary:ACRT, Inc. is seeking a skilled Vegetation Management Specialist to join our team. As a key member of our team, you will be responsible for performing identification, inspection, and evaluation of trees and brush along utility lines. Your expertise will be utilized to submit inspection results to clients with recommendations, plan, direct, and...
-
Clinical Operations Manager
2 weeks ago
Cincinnati, Ohio, United States ChenMed Full timeWe are seeking a skilled Clinical Manager, Registered Nurse to lead our clinical care operations. As a leader in our organization, you will be responsible for overseeing the clinical care operations, ensuring high-quality patient care, and collaborating with the management team to achieve organizational goals.Key Responsibilities:Oversee clinical teams to...
-
Clinical Therapist
2 weeks ago
Cincinnati, Ohio, United States Talbert House Full timeJob SummaryWe are seeking a highly skilled Clinical Therapist to join our team at Talbert House. As a Clinical Therapist, you will be responsible for providing individual and group counseling services to clients, participating in interdisciplinary treatment planning, and developing comprehensive diagnostic assessments.Key ResponsibilitiesProvide counseling,...
-
Clinical Research Manager
4 weeks ago
Cincinnati, Ohio, United States University of Cincinnati Full timeJob Title: Clinical Research Manager / Clinical Research DirectorJoin the University of Cincinnati's Department of Psychiatry and Behavioral Neuroscience as a Clinical Research Manager or Clinical Research Director. This is an exciting opportunity to participate in the planning, implementation, and evaluation of multiple, complex research programs.Key...
-
Clinical Research Manager
2 weeks ago
Cincinnati, Ohio, United States Medpace Full timeJob Title: Clinical Research ManagerMedpace is seeking a highly skilled Clinical Research Manager to join our Clinical Coding & Support team. As a key member of our team, you will be responsible for managing the day-to-day functions of the Clinical Data Reviewers, ensuring team assignments are maintained, and allocating resources within each...
-
Cincinnati, Ohio, United States UC Health Full timeAbout the RoleWe are seeking a skilled Radiology Technologist to join our team at the Pain Management Clinic, working first shift at University of Cincinnati Medical Center.This is a full-time opportunity with a competitive salary and benefits package, including a sign-on bonus of up to $8,000.Key ResponsibilitiesSupport the Pain Management Clinic team in...
Clinical Utilization Manager
2 months ago
Shaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.
About the Role:This is a unique opportunity to work in a dynamic and fast-paced environment, collaborating with healthcare professionals to review medical necessity and ensure the best possible outcomes for our patients.
Responsibilities:- Perform admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines.
- Collaborate with primary nurses and other healthcare providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
- Manage observation level of care and work with attending physicians and/or clinical providers to ensure observation status does not exceed 48 hours.
- Identify system issues that serve as barriers to care and participate in development and implementation of strategies to remove barriers and facilitate performance improvement measures.
- Monitor efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
- Report information generated from the utilization management referral process for LOS data and physician profile database.
- Collaborate with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Notify physicians when patients do not meet criteria for acute care hospitalization and pursue documentation to justify continued stay within 24 hours.
- Collaborate with the Physician Advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Present "Letters of Non-Coverage" to patients and/or families when acute stay is no longer necessary (Third Party and/or Medicare).
- Communicate and secure continued stay authorization with Managed Care Organizations.
- Track all carve-outs and submit reason codes for data entry.
- Serve as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
- Trend potential barriers to patient advancement through the system, intervene assertively and appropriately when necessary.
- Provide on-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to Christiana Care.
- Identify need for patients to be evaluated by other members of the healthcare team and take appropriate action to facilitate.
- Active DE RN licensure or compact state RN licensure.
- Bachelor's degree in nursing.
- Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting.
- Clinical documentation, performance improvement, case management, or utilization management experience desirable.
- Completes a minimum of 8 continuing education credits (CEU's) per year in utilization and/or case management.
- Actively participates in department operational planning work groups.
- Medical, dental, vision, life insurance, tuition assistance, etc.
- Two retirement planning offerings, including 403(b) with company contributions.
- Generous paid time off with annual rollover and opportunities to cash out.
- 12-week paid parental leave.
- Incredible work/life benefits, including annual membership to, access to backup care services for dependents through, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets, and much more.
Christiana Care is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. Christiana Care includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a free-standing emergency department, a Level I trauma center, a Level III neonatal intensive care unit, a comprehensive stroke center, and regional centers of excellence in heart and vascular care, cancer care, and women's health.
