- Highmark Health (Atlanta, GA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- SAM LLC (Atlanta, GA)
- …Manager is responsible for oversight and reporting on spending and budget, utilization of resources, tracking deliverables, handling of field and office day-to-day ... the backup to their Project Manager, assisting with billing review , and proposal writing and review . +...responsible for oversight and reporting on spending and budget, utilization of resources, tracking deliverables, handling of field and… more
- Highmark Health (Atlanta, GA)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- Genesis Healthcare (Lilburn, GA)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area Director in the hiring ... 7. Participates in and coordinates the timely completion of the annual merit review for therapy staff. 8. Assumes responsibility for hiring therapy staff (in… more
- Highmark Health (Atlanta, GA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …schedules. + Proactively manages access scorecard, including 3rd next, No-show, room utilization , and appointment utilization , and identifies trends. + Works ... scheduling changes). + Monitor and act on the appointment utilization capacity report. + Monitor and act on physician...reports as requested. + Assist with new system module review and implementation. + Performs other related duties as… more
- Humana (Atlanta, GA)
- …health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present educational… more
- Oracle (Atlanta, GA)
- …are achieved, maintenances are performed with minimal risk, manage capacity utilization , address local maintenance requirements, and support technical projects. The ... responsibilities include change management, incident & event support, space utilization , efficiency upgrades, and general engineering support. Directors are expected… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …development and execution of biomarker plans as well as identification and utilization of emerging biomarker and translational tools, new technologies and scientific ... in TM group. **Job Description** + Oversee identification and utilization of emerging Biomarker, Translational tools, new technologies and...for target validation and discovery of new compounds. + Review and approve INDs, NDAs and CTAs. + Support… more
- Molina Healthcare (Savannah, GA)
- …analysts on software applications, business domain and design standards. *Conducts peer review of other analysts (internal and contract staff) to ensure standards ... Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among… more