- Humana (Atlanta, GA)
- …on average) Eastern Time Zone hours** **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid ... experience, and judgement to make determinations whether requested services, level of care , and/or site of service should be authorized. All work occurs within… more
- Highmark Health (Atlanta, GA)
- …Doctor of Pharmacy degree + Active pharmacist license + 4 years of experience in managed care pharmacy + 2 years of clinical account management experience in ... Medicare as part of the 4 year managed care experience + 2 years of experience analyzing pharmaceutical cost of care data **Substitutions** + None… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …policies and procedures to comply with medial staff bylaws, hospital bylaws, managed care policies, TJC/NCQA requirements and related state and federal ... + Five (5) years comprehensive Medical Staff Services in an acute care hospital, managed care or credentialing verification organization with three (3) years… more
- Humana (Atlanta, GA)
- …while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement ... - Medicaid health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies… more
- Fresenius Medical Center (Atlanta, GA)
- …with management and executives to determine appropriate plan of action. Supports Managed Care staff in budgeting and forecasting activities. PRINCIPAL DUTIES ... + Responsible for timely and accurate communication of revenue reporting to Managed Care Management Team. + Responsible for compliance with all related data… more
- Molina Healthcare (Macon, GA)
- …health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Proficiency with retrieving specified ... utilized in medical coding/billing (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Elevance Health (Atlanta, GA)
- …acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. For candidates ... will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic… more
- Elevance Health (Atlanta, GA)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred for associates performing medical management.… more
- CenterWell (Atlanta, GA)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... caring community and help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims. The Medical Director,… more
- CenterWell (Atlanta, GA)
- …required. + Familiar with CAQH + Bilingual; English & Spanish + Experience in managed care or health care administration desired **Additional Information** + ... regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional… more