Clinical Financial Case Manager

3 days ago


Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time
Job Summary

This role utilizes clinical knowledge to manage the complex process of coordinating insurance verification and prior authorization of outpatient medications. The successful candidate will provide evidence to support cutting-edge therapies, provide clinical education to payers regarding current standard of care treatment, and identify trends and areas for needed clinical education to decrease denials where applicable.

Key Responsibilities
  • Coordinates insurance verification and prior authorization of outpatient medications
  • Provides evidence to support cutting-edge therapies
  • Provides clinical education to payers regarding current standard of care treatment
  • Identifies trends and areas for needed clinical education to decrease denials where applicable
  • Submits test claims proactively to support clinicians in efforts to identify areas where risk of denial is high to mitigate that risk
Requirements
  • Bachelor's degree in Nursing, Pharmaceutical Sciences, or similar clinical healthcare field
  • At least 1 year of clinical experience, preferably in the field of oncology and/or pharmacy
  • Experience in physician practice and/or utilization review a plus
  • Knowledge of Medicare and commercial insurance reimbursement desired
  • Strong knowledge of medical and pharmaceutical terminology highly desired
  • Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred
  • Excellent verbal and written skills required
  • Proficient in the use of computer-based research and medical record documentation required
  • Experience in interpreting insurance benefit information and completing prior authorization process preferred


  • Columbus, Ohio, United States InsideHigherEd Full time

    Job Title:Clinical Financial Case ManagerDepartment:James | Pharmacy Medication AccessScope of Position:The Clinical Financial Case Manager plays a critical role in ensuring the financial integrity of our clinical operations. This position is responsible for establishing and implementing financial controls, executing financial operations, and preparing and...


  • Columbus, Ohio, United States InsideHigherEd Full time

    Job Title:Clinical Financial Case ManagerDepartment:James | Pharmacy Medication AccessScope of Position:The Clinical Financial Case Manager will be responsible for establishing financial controls and policies, ensuring their implementation and effectiveness, executing financial operations, preparing and interpreting financial and operational reports, and...


  • Columbus, Ohio, United States InsideHigherEd Full time

    Job Title: Clinical Financial Case ManagerWe are seeking a highly skilled Clinical Financial Case Manager to join our team. As a Clinical Financial Case Manager, you will be responsible for managing the complex process of coordinating insurance verification and prior authorization of outpatient medications.Key Responsibilities:Utilize clinical knowledge to...


  • Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time

    Job Title: Clinical Financial Case Management Specialist 2Job Summary:The Clinical Financial Case Management Specialist 2 will utilize clinical knowledge to manage complex ambulatory medical necessity denials through the appeals process. This role will provide scientific evidence to support cutting-edge therapies and diagnostic services, as well as clinical...


  • Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time

    Job SummaryThis position utilizes clinical knowledge to manage the complex process of coordinating insurance verification and prior authorization of outpatient medications. The successful candidate will provide evidence to support cutting-edge therapies, provide clinical education to payers regarding current standard of care treatment, and identify trends...


  • Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time

    Job Summary:The Clinical Financial Case Manager will utilize clinical knowledge to manage complex ambulatory medical necessity denials through the appeals process. This role will provide scientific evidence to support cutting-edge therapies and diagnostic services, as well as clinical education to payers regarding current standard of care treatment and...

  • Clinical Case Manager

    2 weeks ago


    Columbus, Ohio, United States Select Medical Full time

    Job Title: Clinical Case ManagerAt Select Medical, we are seeking a highly skilled and compassionate Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a vital role in ensuring the seamless transition of patients from acute care to post-acute care settings.Key Responsibilities:Conduct thorough assessments of patients' medical...


  • Columbus, Ohio, United States The Ohio State University Full time

    Job Title: IRP-Clinical Case Manager (RN)Department: University Hospital | Social Work and Case Management AdministrationJob Summary: The Clinical Case Manager facilitates an assigned group of patients through the healthcare system with the primary focus of efficient, effective, and compassionate inpatient care and a safe transition to the outpatient...


  • Columbus, Ohio, United States The Ohio State University Full time

    Job Title: IRP-Clinical Case Manager (RN)Department: University Hospital | Social Work and Case Management AdministrationScope of Position/Position Summary:The Clinical Case Manager plays a vital role in facilitating the healthcare journey of patients, ensuring efficient and effective care throughout the inpatient process. This involves collaborating with...


  • Columbus, Ohio, United States The Ohio State University Full time

    Job Title: IRP-Clinical Case ManagerThe Ohio State University is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will be responsible for facilitating an assigned group of patients through the healthcare system, ensuring efficient and effective inpatient care and a safe transition to the outpatient setting.Key...

  • Clinical Case Manager

    3 weeks ago


    Columbus, Ohio, United States InsideHigherEd Full time

    Job Title: Clinical Case Manager - RNAt The Ohio State University, we are seeking a highly skilled Clinical Case Manager - RN to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the efficient and effective delivery of patient care.Scope of Position:The Clinical Case Manager - RN will be responsible for...

  • Clinical Case Manager

    3 weeks ago


    Columbus, Ohio, United States InsideHigherEd Full time

    Clinical Case Manager Job SummaryWe are seeking a skilled Clinical Case Manager to join our team at The Ohio State University. As a Clinical Case Manager, you will play a critical role in facilitating the care of patients through the healthcare system, ensuring efficient and effective care and a safe transition to the outpatient setting.Key...


  • Columbus, Ohio, United States InsideHigherEd Full time

    Job Title: IRP-Clinical Case ManagerAt The Ohio State University, we are seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating the care of patients through the healthcare system, ensuring efficient and effective inpatient care and a safe transition to the outpatient setting.Key...


  • Columbus, Ohio, United States InsideHigherEd Full time

    Job Title: IRP-Clinical Case Manager (RN)Job Summary:The Clinical Case Manager RN is responsible for facilitating an assigned group of patients through the healthcare system, ensuring efficient and effective inpatient care and a safe transition to the outpatient setting. This role involves monitoring patient care processes, documenting and communicating data...

  • Financial Manager

    2 days ago


    Columbus, Ohio, United States Creative Financial Staffing Full time

    Financial Manager OpportunityWe are seeking a highly skilled Financial Manager to join our team at Creative Financial Staffing. The ideal candidate will have experience in accounting and finance, with a strong background in financial management.The Financial Manager will be responsible for:Managing financial statements and reportsCoordinating with outside...

  • Travel Nurse Case Manager

    27 minutes ago


    Columbus, Ohio, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 8 weeksHours: 40 hours per weekShift: 8 hours, daysEmployment Type: TravelAbout TotalMed Case Management StaffingWe are a team who really cares, providing gold standard customer...


  • Columbus, Ohio, United States The Ohio State University Full time

    Job Title: IRP-Clinical Case ManagerAbout the Role:The Ohio State University is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating the care of patients through the healthcare system, ensuring efficient and effective care, and a safe transition to the outpatient setting.Key...

  • Financial Manager

    4 weeks ago


    Columbus, Ohio, United States Creative Financial Staffing Full time

    Controller PositionCreative Financial Staffing is seeking a highly skilled Controller to join their team. The ideal candidate will have a strong background in accounting and finance, with experience in managing financial operations and leading a team.Key Responsibilities:Manage financial planning, budgeting, and forecastingOversee financial reporting and...


  • Columbus, Ohio, United States TotalMed Case Management Staffing Full time

    Job DetailsTotalMed Case Management Staffing is seeking a skilled travel nurse RN case manager to join their team.Specialty: Case ManagementDiscipline: RNAssignment Length: 8 weeksTotal Hours Per Week: 40Shift Breakdown: 5x8 hoursAs a travel nurse case manager, you will be responsible for providing high-quality patient care and management services to...

  • Financial Manager

    3 weeks ago


    Columbus, Ohio, United States Creative Financial Staffing Full time

    Controller PositionCreative Financial Staffing is seeking a highly skilled Controller to join their team. The ideal candidate will have a strong background in accounting and finance, with experience in managing financial operations and leading a team.Key Responsibilities:Manage financial planning, budgeting, and forecastingOversee financial reporting and...