- Centene Corporation (Atlanta, GA)
- …knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- CVS Health (Atlanta, GA)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors… more
- Evolent Health (Atlanta, GA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Reviewer you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent Health (Atlanta, GA)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and sustainable improvements. + Work with nursing department leaders, Quality Management and accreditation specialist to improve staff competency, compliance ... CNO, the ACNO serves as a member of the senior leadership team for nursing. Serves in the absence...tactical level. + Maintain personal development plan and provide management development and coaching for other members of the… more
- Elevance Health (Atlanta, GA)
- …problem solving with providers, claims or service issues. Assists with development of utilization /care management policies and procedures. + Within the medical ... **The Transplant Nurse II** is responsible for providing case management and/or medical management (UM/UR) for members...on the team in preparation for advancement to the senior level. Primary duties may include, but are not… more