- GHR Healthcare (Atlanta, GA)
- …making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare ... business hours) Type: Temp to Hire (Candidates will be remote but need to reside in the tri-state area...-40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient… more
- Careers Integrated Resources Inc (Atlanta, GA)
- …Coding experience Requires a minimum of 5+ years' experience in Health Insurance/quality chart audits and/or Utilization Review Bachelor's degree required ... Job Title: Senior Professional Coder Location: 100% Remote Duration: 6+ months (possible extension) Schedule: Regular Business Hours Candidates must be located in… more
- Pacer Staffing (Atlanta, GA)
- …regulatory requirements, and HIPAA privacy regulations. . Thorough knowledge of Case Management , Utilization Management , HIPAA Privacy and Security ... Job Summary . Provides Disease Management (DM) services to TRICARE beneficiaries. . The.... Onsite: Works within a standard office environment . Remote : Private and secure workspace and workstation with high-speed… more
- Pacer Staffing (Atlanta, GA)
- …direction and build group engagement. Technical Skills: Thorough knowledge of Case Management , Utilization Management , TRICARE policies and procedures, HIPAA ... Shift - Standard | Mon to Fri Location - Remote (Case Manager - serious diagnoses. Children/Pediatric with down syndrome, serious disabilities, physical… more
- Rose International (Atlanta, GA)
- …physician filings and decisions on appropriate treatments recommended by utilization review .Maintains professional client relationships.ADDITIONAL FUNCTIONS and ... of claims and negotiate settlements.SIP a plus- Must live in California. Position is remote but must live in CA.Min 3+ years as indemnity examiner handling CA Claims… more
- Centene Corporation (Atlanta, GA)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management… more
- Evolent Health (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Elevance Health (Atlanta, GA)
- **Anticipated End Date:** 2024-09-13 **Position Title:** Utilization Management Rep I **Job Description:** **Title: Utilization Management Representative ... I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50...50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible… more
- Prime Therapeutics (Atlanta, GA)
- …Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service ... **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases...guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization… more
- Marriott (Atlanta, GA)
- …be employed by a franchisee and not by Marriott International, Inc. JOB SUMMARY: The remote role of the Director Revenue Management is to provide direction to ... **Job Number** 24136294 **Job Category** Revenue Management **Location** Laguna Cliffs Marriott Resort & Spa,...full service premium branded hotel. This position is a remote position encompassing 25% in the office or one… more
- Prime Therapeutics (Atlanta, GA)
- …support to one or more of Prime's functional areas: Clinical Program Management , Utilization Management (UM), Formulary, GuidedHealth, Pharmaceutical Trade ... internal program reporting, which may include UM Savings, Compliance, Utilization data, Retrospective Drug Utilization Review... skills + Knowledge or experience with formulary or utilization management + Proficient in MS Access… more
- Prime Therapeutics (Atlanta, GA)
- …every decision we make. **Job Posting Title** Health Data Analyst - Remote **Job Description** The Health Data Analyst provides information, analyses, and ... responsible for Centers for Medicaid/Medicare Services reporting and analysis, including the management of directories and bid support + Other duties as assigned… more
- Highmark Health (Atlanta, GA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Prime Therapeutics (Atlanta, GA)
- …**Job Posting Title** Contract Manager Vendor Performance - LA Medicaid - Remote **Job Description Summary** Responsible for the implementation and support of all ... all areas of the Prime Therapeutics organization to coordinate network management and network administration responsibilities and facilitates resolution of contract… more
- Prime Therapeutics (Atlanta, GA)
- …and written communication skills. + Knowledge of legislative/oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers for Medicare & ... **Job Posting Title** Director, Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary** Responsible for support and development of… more
- Prime Therapeutics (Atlanta, GA)
- …the primary clinical relationship manager. This role's responsibilities may include the management of drug formulary, Utilization Management (UM) programs, ... every decision we make. **Job Posting Title** Clinical Program Mgmt Director - Remote Must Reside in Alabama **Job Description** The Clinical Program Management … more
- Prime Therapeutics (Atlanta, GA)
- …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... drives every decision we make. **Job Posting Title** Clinical Program Manager Remote **Job Description** **This Clinical Program Manager opening is presenting a… more
- Prime Therapeutics (Atlanta, GA)
- …drives every decision we make. **Job Posting Title** Marketing Manager - Remote **Job Description** The Marketing Manager is responsible for driving the development ... stakeholders to understand Prime's business objectives, product offerings, client utilization /adoption and history, and intended market positioning + Translate… more
- Prime Therapeutics (Atlanta, GA)
- …every decision we make. **Job Posting Title** Sr. Director Actuarial Services - Remote **Job Description** The Senior Director of Actuarial Services leads a team of ... complex actuarial modeling + Collaborates with underwriters, client engagement, and senior management on RFP process and other pricing initiatives related to all… more
- Sharecare, Inc. (Atlanta, GA)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
