- Emory Healthcare/Emory University (Atlanta, GA)
- …and effectiveness. 5. Provides transplant program information during negotiation of managed care transplant contracts. Education, Research, and Consultation: 1. ... practice models for designated transplant patient populations across the continuum of care . This role utilizes critical thinking and analysis along with clinical… more
- CenterWell (Atlanta, GA)
- …minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates ... caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate...seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical … more
- Molina Healthcare (Augusta, GA)
- …new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified ... for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide… more
- Morehouse School Of Medicine (Atlanta, GA)
- …indicated with an asterisk (*). + Have you been previously denied participation in any managed care organizations? (Open Ended Question) + * Do you have a ... of the health professional and scientific workforce; * Address primary health care through programs in education, research and service; With emphasis on people… more
- 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 ... is at the forefront of our commitment to the care and improvement of human life. At HCA Healthcare,...units of distinction. We learn from our multi-generational patient care family. We partner with all of our Nurses… more
- Molina Healthcare (Macon, GA)
- …Required Qualifications* At least 5 years of operations or administrative experience in health care , preferably within a managed care setting, or equivalent ... and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of … more
- Datavant (Atlanta, GA)
- …payor guidelines. * **What you will bring to the table:** + Two (2) years managed care experience in UM/CM/CDI Department preferred + Knowledge of CMS, State ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...and necessity of continued stay in the inpatient patient care setting and/or discharge to an alternative level of… more
- Prime Therapeutics (Atlanta, GA)
- …Care Exchange business or other Government Programs lines of business + Managed care experience + Experience in Project Management/Ownership + Experience with ... purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven...the Individual and Small Group Exchanges under the Affordable Care Act. This position ensures quality and compliance standards… more
- Molina Healthcare (Macon, GA)
- …experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent ... to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching...to overarching strategy to provide quality and cost-effective member care . Essential Job Duties * Leads a team of… more
- Elevance Health (Atlanta, GA)
- …or related field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience ... Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving… more