• Program Implementation Advisor

    Sedgwick (Atlanta, GA)
    …of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In depth ... knowledge of claims management, managed care and/or absence management processes and procedures + Excellent oral and written communication, including… more
    Sedgwick (08/27/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Atlanta, GA)
    …Review + 3 years of experience in Account Support + 1 year of experience in Managed Care Support + 1 year of experience in Consulting **SKILLS** + In-depth ... bachelor's degree. **Substitutions** + 6 years experience in pharmacy or managed health care setting in lieu of Bachelor degree **Preferred** + Master's degree… more
    Highmark Health (08/26/25)
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  • Manager, Provider Network Administration (Remote)

    Molina Healthcare (GA)
    …equivalent combination of education and experience **Required Experience** * 5-7 years managed care experience, including min. 2 years of supervisory experience ... N/A **Preferred Education** Bachelor's Degree **Preferred Experience** * 7+ years managed care experience * QNXT; SQL experience * Crystal Reports for data… more
    Molina Healthcare (08/13/25)
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  • Senior Specialist, Provider Network Administration

    Molina Healthcare (Columbus, GA)
    …or equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or ... higher) **Preferred Education** Bachelor's Degree **Preferred Experience** + 5+ years managed care experience + QNXT; SQL experience + Crystal Reports for data… more
    Molina Healthcare (08/02/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Atlanta, GA)
    …experience. + Certification as a Case Manager. + Minimum 2 years' experience in acute care setting. + Managed Care experience. + Ability to talk and ... 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 (08/28/25)
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  • Health Coach Consultant

    CVS Health (Atlanta, GA)
    …Office Suite (including Outlook and Microsoft Word). **Preferred Qualifications:** - Managed Care experience preferred. -Previous coaching experience preferred. ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
    CVS Health (08/28/25)
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  • Social Worker MSW

    HCA Healthcare (Savannah, GA)
    …payer regulations and processes. You will possess a thorough understanding of managed - care concepts and length-of-stay management relating to patient and ... are at the forefront of our commitment to the care and improvement of human life. At HCA Healthcare,...other identified resource needs. The MSW assists in post-acute care placement on all discharges, primarily with those patients… more
    HCA Healthcare (08/23/25)
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  • RN - Plan Case Manager

    PruittHealth (Atlanta, GA)
    care experience required. * Minimum three years industry experience in a managed care setting focused on experience in utilization review/case management and ... **JOB PURPOSE:** Responsible for the oversight of clinical care management of community based long-term care...clinical care management of community based long-term care population for PruittHealth Premier Dual Eligible Special Needs… more
    PruittHealth (08/23/25)
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  • RN Lead, HCS (Clinical) Remote with field travel…

    Molina Healthcare (Savannah, GA)
    …Degree in Nursing preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or care management ... team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for… more
    Molina Healthcare (08/15/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Atlanta, GA)
    …of the cost of residential broadband service. **Preferred Qualifications** + 1+ years Managed Care (MCO) preferred. + 1+ years demonstrated experience working in ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
    CVS Health (08/15/25)
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