- 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
- 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 (Atlanta, 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)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... - unrestricted + Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus + Previous 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
- Guardian Life (Atlanta, GA)
- …re-credentialing activities, and reviewing with the group any identified outlier utilization patterns. You are An experienced dental network ... of Guardian's network through developing partnerships and providing outstanding service to Dental Support Organization (DSO) partners. As a **Key DSO Dental … more