- Molina Healthcare (Atlanta, GA)
- …Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads ... SKILLS & ABILITIES** : + 2 or more years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of… more
- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Molina Healthcare (Atlanta, GA)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Elevance Health (Atlanta, GA)
- …commute to the Elevance Health major office (PulsePoint) location listed above. The **Medical Management Nurse ** is responsible for review of the most ... **Medical Management Nurse ** **Office Location** : Atlanta,...experience and requires a minimum of 2 years clinical, utilization review , or case management … more
- Humana (Atlanta, GA)
- …licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Molina Healthcare (Atlanta, GA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Atlanta, GA)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Elevance Health (Atlanta, GA)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager II** **Location: This is a... Case Manager II** is responsible for performing care management within the scope of licensure for members with… more
- Elevance Health (Atlanta, GA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64040/other-jobs-matching/location-only)...services, and appropriateness of services rendered based on chart review and client interview and assessment. + Maintains a… more
- Fresenius Medical Center (Lithonia, GA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Molina Healthcare (Atlanta, GA)
- …authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Molina Healthcare (Atlanta, GA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Evolent (Atlanta, GA)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Molina Healthcare (Atlanta, GA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management… more
- CenterWell (Cumming, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- PruittHealth (Norcross, GA)
- …and in ensuring appropriate data elements are included in the POC. + Review visit utilization for appropriateness as per care guidelines, best practices, ... Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents. The EAC ensures all services and… more
- Highmark Health (Atlanta, GA)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Molina Healthcare (Atlanta, GA)
- …Minimum of 6 years' experience in health care * Understanding of clinical operations: utilization management , case management , etc. * Ability to provide ... **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans within Molina Healthcare. In this position you will be assisting… more