• Pharmacist, Utilization Management ( UM…

    Molina Healthcare (Columbus, GA)
    …medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and ... in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a...changes for the upcoming year. + Works with the Case Management department as part of a member-centered interdisciplinary… more
    Molina Healthcare (10/16/25)
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  • Behavioral Health - Care Manager II

    Elevance Health (Atlanta, GA)
    **Behavioral Health - Care Manager II** **Location** : _Virtual:_ This role enables associate to work virtually full-time, with the exception of required in-person ... as required by law. The **Behavioral Health - Care Manager II** is responsible for managing psychiatric and substance...healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to… more
    Elevance Health (10/22/25)
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  • Lead Trainer - Clinical Services (Remote in GA)

    Molina Healthcare (Savannah, GA)
    …or State Clinical Social Worker/Counseling (or related field) License Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... or State Clinical Social Worker/Counseling (or related field) License Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified… more
    Molina Healthcare (10/30/25)
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  • Care Manager RN - (Remote)

    Highmark Health (Atlanta, GA)
    …resource utilization, identification of opportunities for referral to a Health Coach/ case management, and identification and resolution of quality issues. Monitors ... with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable state, federal… more
    Highmark Health (10/22/25)
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  • Family Health Advocate - Remote

    Sharecare (Atlanta, GA)
    …days of training. PTO needs during the training period will be evaluated on a case by case basis and must be approved in advance._ **Compensation:** $22.00/hour ... hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision… more
    Sharecare (10/14/25)
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  • Medical Director (NV)

    Molina Healthcare (Macon, GA)
    …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and under-utilization. * Educates… more
    Molina Healthcare (10/31/25)
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