- Legend Biotech USA, Inc. (Atlanta, GA)
- …Affairs team. Direct education for healthcare professionals treating oncology patients on clinical data, adverse event management , and mechanism of action for ... and members of the Legend Biotech Medical Affairs and Clinical Development teams; Addressing AE management and...local point of contact for investigators and their research staff who may participate in company sponsored and investigator… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be… more
- Emory Healthcare/Emory University (Decatur, GA)
- …development _,_ and leadership programs + And more **Description** We're seeking a ** Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This ... clinical expert, leader, and role model within the Utilization Review Department as it relates to the understanding...audits. + Will assist with the development of both clinical and administrative skills by ensuring the staff… more
- CenterWell (Marietta, GA)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- Evolent (Atlanta, GA)
- …a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff , other CR's ( Clinical Reviewers), providers, office staff ... Nurse, you will be a key member of the utilization management team. We can offer you...standards in the participating provider network and for other clinical staff . + Converses with medical office… more
- Danaher Corporation (Atlanta, GA)
- …includes some of the following: infection detection/control, sepsis care, decision support, utilization management , case management , ED patient workflow, ... - innovating at the speed of life. As a global leader in clinical diagnostics, Beckman Coulter Diagnostics has challenged convention to elevate the diagnostic… more
- CenterWell (Atlanta, GA)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...May perform work associated with patient care assignments and staff management activities. + Acts as Branch… more
- Elevance Health (Atlanta, GA)
- …advanced analytics, AI/ML, and automation to reduce medical spend and improve utilization management . Engineering Execution + Lead large-scale engineering teams ... Staff VP will partner with business leaders in Clinical , Actuarial, Network, Finance, and Product organizations to deliver...Medical Cost Management (claims review, payment integrity, utilization management , risk adjustment). + Cost of… more
- J&J Family of Companies (Atlanta, GA)
- …beyond the EP/IC lab, including, but not limited to physicians, nurses and technicians, clinical and hospital administrators and staff . + Stay current on company ... Description:** We are searching for the best talent for **Sr. Ultrasound Clinical Account Specialist** to be in **Atlanta, GA.** **About Cardiovascular** Fueled by… more
- State of Georgia (Dekalb County, GA)
- … Clinical Manager. + Assists in managing social service personnel, including staff coverage, through collaboration with the Clinical Manager. + Demonstrates ... Actively support agency goals and Clinical Manager. + Work in conjunction with Clinical Manager to inspire staff to adhere to policy and procedure. SKILL,… more
- Fresenius Medical Center (Atlanta, GA)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- Humana (Atlanta, GA)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Cardinal Health (Atlanta, GA)
- **Ideal candidate will live near a major/regional airport.** **_What Clinical Operations contributes to Cardinal Health_** Clinical Operations is responsible for ... and service education to facilitate technology adoption and workflow change management . + Demonstrates extensive knowledge and understanding of relevant clinical… more
- Wider Circle (Atlanta, GA)
- …scheduling, escalation protocols, documentation standards, and QA. + Own coordination between clinical staff , product, and data teams. + Step into operational ... and empathy. Requirements What You'll Bring + 5-8 years of experience in clinical operations, care management , or tech-enabled care - ideally in digital… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Evolent (Atlanta, GA)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION Job SummaryProvides support for pharmacy Medication Therapy Management (MTM) activities. Contributes to overarching pharmacy strategy to ensure ... in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. *… more
- Highmark Health (Atlanta, GA)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Molina Healthcare (Atlanta, GA)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff . + Marketplace UM reviews + MD licenses required for ... resource management . + Develops and implements a Utilization Management program and action plan, which...clinical lead, the medical director, and quality improvement staff . + Facilitates conformance to Medicare, Medicaid, NCQA and… more
