- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Authorize and review utilization of dental services provided in provider ... a resource between the health plan, provider relations, and dental providers + Review treatment plans and...of Georgia + 3+ years of Utilization Management or Clinical Experience in a Dental … more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible… more
- Actalent (Atlanta, GA)
- Utilization Review (Registered Nurse) Job Description...GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of ... care. Additional Skills & Qualifications + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job Type & Location This is… more
- Humana (Atlanta, GA)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time… more
- Elevance Health (Columbus, GA)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... ** Utilization Management Medical Director- NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Cognizant (Atlanta, GA)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Atlanta, GA)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- CenterWell (Atlanta, GA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Highmark Health (Atlanta, GA)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... internally and externally (providers, dental industry, organized dentistry and dental consultants) keeping management informed on related healthcare industry… more
- Stantec (Atlanta, GA)
- …Your Opportunity The Commissioning Analyst performs basic technical and project management duties under the supervision of a Senior Commissioning Authority or ... intent and scope of work outlined in proposals. - Follows the quality management process; reviews project deliverables prior to submission to QA/AC reviewer .… more