- Battelle Memorial Institute (Fort Benning, GA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …the laboratory at functions or committees such as multidisciplinary tumor boards, transfusion utilization review , and others. Participating in the review of ... are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. Former… more
- CenterLight Health System (Bostwick, GA)
- …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
- Molina Healthcare (Macon, GA)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...also entails producing audit reports for internal and external review . The position may also work with other internal… more
- Elevance Health (GA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Elevance Health (Atlanta, GA)
- …Associate Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review ** **Virtual** : This role enables ... medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.… more
- HCA Healthcare (Waycross, GA)
- …responsibility typically includes Accounting, Reimbursement, Managed Care, Health Information, and Utilization Review . Functions at an executive level in an ... administration, appropriate facility staff members and Division Office. + You will review denials issues and trends for maximizing net reimbursement for Facility.… more
- Ascendis Pharma (GA)
- …Institute for Clinical and Economic Review (ICER) and state Drug Utilization Review Boards (DURBs)). HCP Relationship Management + Through appropriate ... and initiates and manages collaborative external and/or internal projects upon alignment, review and approval + Participates on internal project teams as directed by… more
- CenterWell (Atlanta, GA)
- …by accessing and understanding formulary restrictions, plan limitations, drug utilization review overrides, requesting and completing prior authorization, ... good practices within the value-based model. + Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations.… more
- PruittHealth (Atlanta, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... for each patient based on a thorough history and clinical record review , including the attending physician's plan, the recommendations of national guidelines, social… more