- Molina Healthcare (Savannah, GA)
- …preferred. **Required Experience** + 3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan ... of service provided, length of stay and level of care . + Applies appropriate criteria on PAR and Non-PAR...& Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases in conjunction… more
- Highmark Health (Atlanta, GA)
- …Consulting or related area + 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery ... and maintains strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts… more
- Peachtree Orthopedics (Atlanta, GA)
- …preferred. + Familiar with CMS 1500/UB04 claim form completion, knowledge of Medicare, Managed care and commercial insurance products and plans. + Knowledge of ... offices across Greater Atlanta, we're committed to providing top-notch care and your skills and passion can make a...but we take pride in delivering dedicated and compassionate care to everyone who walks through our doors. If… more
- Prime Therapeutics (Atlanta, GA)
- …account management, and strategy development experience in PBM, pharmacy, health plan and/or managed care + 10 years of leadership/people management experience + ... as assigned **Education & Experience** + Bachelor's degree in Finance, Business, Health Care Administration, or related area of study + 15 years of relevant work… more
- Prime Therapeutics (Atlanta, GA)
- …agreements. + Invoicing practices, including pre-invoicing review for fee for service, managed care , diabetic supply and supplemental rebate programs. + Assists ... for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded...and work collaboratively to provide the highest quality of care and service to our members. If you are… more
- Humana (Atlanta, GA)
- …continuously improving the consumer experience **Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review ... clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall… more
- Pfizer (Atlanta, GA)
- …leaders or high influence customers in large group practices, hospitals, or managed care organizations preferred. + Strong organizational and analytical skills ... reports payments and other transfers of value to health care providers as required by federal and state transparency...provide government agencies with information such as a health care provider's name, address and the type of payments… more
- Elevance Health (Atlanta, GA)
- …through strong communication and interpersonal skills. + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as ... such as contract negotiations, provider network optimization, and total cost of care management. + Thoroughly vet and perform due diligence on potential value-based… more
- Prime Therapeutics (Atlanta, GA)
- …technology function or similar area for a Pharmacy Benefit Manager (PBM), health plan, or managed care organization + Must be eligible to work in the United ... for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded...and work collaboratively to provide the highest quality of care and service to our members. If you are… more
- CVS Health (Atlanta, GA)
- …of healthcare and/or analysis experience. **Preferred Qualifications** * Extensive knowledge of managed care and how provider reimbursement policies relate to ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more