- Highmark Health (Atlanta, GA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans… more
- Molina Healthcare (Augusta, GA)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- CenterWell (Atlanta, GA)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Elevance Health (Atlanta, GA)
- …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of ... by law. The **Medical Management Nurse** is responsible for review of the most complex or challenging cases that...skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has… more
- Elevance Health (Columbus, GA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... in the state of Georgia** The **Medical Management Nurse** is responsible for review of the most complex or challenging cases that require nursing judgment, critical… more
- Elevance Health (Atlanta, GA)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Savannah, GA)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- Elevance Health (Atlanta, GA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- Elevance Health (Atlanta, GA)
- …Associate Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review ** **Virtual** : This role enables ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- YKK AP America Inc. (Dublin, GA)
- …coordinates the sequencing of materials through the process to ensure efficient utilization of resources. + Ability to handle inventory control procedures not ... packing slips and purchase orders; record any discrepancies or damages. + Review and recommend to department leadership improvements related to production methods,… more
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