- Molina Healthcare (Columbus, GA)
- …+ 2 - 3 years customer service, provider service, or claims experience in a managed care setting. + Working familiarity with various managed healthcare ... discuss and resolve issues related to utilization management, pharmacy, quality of care , and correct coding, for example. + Independently delivers training and… more
- Humana (Atlanta, GA)
- …services such as inpatient rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed ... The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments… more
- Molina Healthcare (GA)
- …* 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare ... discuss and resolve issues related to utilization management, pharmacy, quality of care , and correct coding. * Independently delivers training and presentations to… more
- Elevance Health (Atlanta, GA)
- …experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which ... Capabilities, and Experiences:** + Certification in the American Association of Managed Care Nurses is preferred. + Knowledge of the medical management processes… more
- Humana (Atlanta, GA)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an… more
- J&J Family of Companies (Atlanta, GA)
- …to address critical access and affordability issues for patients. + Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). + Execute business in accordance with the highest ethical,… more
- CenterWell (Atlanta, GA)
- …The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care , PBM, market and regulatory insights to develop, and/or ... the Medicaid lines of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights to support the development of… more
- J&J Family of Companies (Macon, GA)
- …to address critical access and affordability issues for patients. + Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). + Execute business in accordance with the highest ethical,… more
- Molina Healthcare (GA)
- …integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in Medicaid and/or… more
- Molina Healthcare (Augusta, GA)
- …integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, or equivalent combination of relevant… more