- Molina Healthcare (GA)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …on current administrative guidelines. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and experience, while fostering standardization and reduction in cost and utilization . + Leads and manages cross functional Value Analysis teams/clinical specialty ... committees responsible for product/service introductions, supporting quality improvement initiatives, utilization and cost containment initiatives, and giving strategic sourcing… more
- Molina Healthcare (Augusta, GA)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Molina Healthcare (GA)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical ... Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health… more
- Molina Healthcare (Macon, GA)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- SpartanNash (Midland, GA)
- …of drivers and deliveries to maximize resources, reduce miles and ensure efficient utilization of equipment and drivers within the assigned location(s). + Manage and ... Operations and Compliance team to ensure compliance with DOT/CSA and safety regulations, review reporting and compliance of the on-board computer system, and to make… more
- Molina Healthcare (Macon, GA)
- …healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare ... utilization and cost containment reports and makes recommendations based...follow up and performance metrics monitoring. + Provides peer review of critical reports and guidance on programming /… 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
- 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