- Prime Therapeutics (Atlanta, GA)
- …Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job Description** The Senior Director Clinical Strategy and Oncology ... implementation of innovative drug solutions, including optimizing optimize drug utilization , patient outcomes, and cost-effectiveness through value-based care models,… more
- Actalent (Atlanta, GA)
- …of cases. Essential Skills + Experience in utilization management, concurrent review , prior authorization, utilization review , case management, and ... + Active Compact RN License, Compact LPN is okay too + Utilization Management/Concurrent Review experience. + ICU/ER experience. + Strong communication… more
- Cognizant (Atlanta, GA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- Molina Healthcare (GA)
- …multiple data sources, crosswalks, and built-in validation checks. + Use peer-to-peer review process and end-user consultation to reduce errors and rework. + Assist ... Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare + Advanced knowledge of Databricks +… more
- Sharecare (Atlanta, GA)
- …techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also ... in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency tests are required for all Sharecare clinicians.… more
- Molina Healthcare (Savannah, GA)
- …requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework + Practice ... + Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare + Advanced knowledge of SQL + Proficient… more
- Centene Corporation (Atlanta, GA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Humana (Atlanta, GA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- CenterWell (Cumming, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... **Branch Location** : Cumming, GA **This is not a remote or work-from-home position. This position requires you to...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- CVS Health (Atlanta, GA)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... with heart, each and every day. **This is full-time, remote position. Candidates can reside anywhere in the US...Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity … more