- Forvis Mazars (Atlanta, GA)
- Description & Requirements The Managed Care Contracting team assists provider clients (health systems, physician practices, accountable care organizations ... and more) in the planning and execution of their critical managed care functions. These functions range from contract negotiation and modeling to rate… more
- Peachtree Orthopedics (Atlanta, GA)
- …preferred. Familiar with CMS 1500/UB04 claim form completion, knowledge of Medicare, Managed care and commercial insurance products and plans. Knowledge of ... offices across Greater Atlanta, we're committed to providing top-notch care and your skills and passion can make a...that align with company goals and enhance customer satisfaction. Lead , mentor, and inspire a team of patient service… more
- Strategic Health Partners (Kennesaw, GA)
- …a requirement *Ability to problem-solve & troubleshoot insurance claim *Working knowledge of Managed Care , Medicare and Medicaid *Knowledge of Word and Excel ... insurances, reporting any delay in unbilled secondary claims to your Lead . *Consistently meet the current productivity standards in addressing and resolving… more
- Petco (Atlanta, GA)
- …the efficient and effective merchandising and inventory management operations of the Pet Care Center. This leader ensures all merchandise is accurately received, ... partners. We are 29,000 strong and operate 1,500+ pet care centers in the US, Mexico and Puerto Rico,...planet is good for Petco. Position Overview The Operations Leader - Merchandise is responsible for operational execution within… more
- Humana (Atlanta, GA)
- …clinical specialists with recent inpatient experience preferred** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Elevance Health (Atlanta, GA)
- …or related field; minimum of 5 years' experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical ... **Provider Contract/Cost of Care Consultant** **Location:** This role requires associates to...Works on complex enterprise-wide initiatives and acts as project lead . **How you will make an impact:** + Uses… more
- Prime Therapeutics (Atlanta, GA)
- …GED is required + 10 years of work experience in pharmacy benefit management, managed care , pharmacy operations or healthcare consultin + 7 years of ... our passion and drives every decision we make. **Job Posting Title** Sr Director Care Solutions - Remote **Job Description** The Senior Director Care Solutions… more
- Molina Healthcare (Atlanta, GA)
- …QUALIFICATIONS:** + At least 8 years of experience in Healthcare Administration, Managed Care , and/or Provider Network Management and Operations with an ... subject matter expertise for the design and implementation of value-based care programs across Medicaid, Medicare, and Marketplace populations, ensuring alignment… more
- Humana (Atlanta, GA)
- …services (such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Humana (Atlanta, GA)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- CVS Health (Atlanta, GA)
- …a willingness to learn about care management within Medicare and Medicaid managed care . + Familiarity with community resources and services. + Navigate ... each and every day. **Program Summary** Join our Aetna care management team as we lead the...Qualifications** + Case management and discharge planning experience + Managed care experience **Education** + High School… more
- Elevance Health (Atlanta, GA)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... to interpret and apply member contracts, member benefits, and managed care products strongly preferred for associates...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Molina Healthcare (Atlanta, GA)
- …guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… more
- Evolent (Atlanta, GA)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations or health systems and large provider groups ... **:** The **VP,** **Growth** **-** **Pay** **e** **r** will lead strategic partnerships with health plans. + Develop and...cycles requiring diverse stakeholder management + Knowledge of the managed care and provider markets (both payers… more
- Molina Healthcare (Atlanta, GA)
- …state priorities, competitive dynamics, and the latest Medicaid trends, positioning Molina as a leader in Medicaid managed care + Track regulatory compliance ... in market strategy, business development, or healthcare consulting, specifically within Medicaid managed care or equivalent related field + Proven experience in… more
- Prime Therapeutics (Atlanta, GA)
- …work experience, including 12 years of experience as an attorney and 5 years representing managed care companies, health care clients, or clients in highly ... member of the legal department's leadership team. **Responsibilities** + Lead and mentor a team of attorneys and support...False Claims Act, with a focus on PBM and managed care operations + Experience engaging with… more
- WTW (Atlanta, GA)
- …including producers, client advocates, broking teams, and sub-segment leaders (Life Sciences, Managed Care & Senior Living) + Actively participate on both ... Role** The Healthcare and Life Sciences (HC&LS) Industry Vertical leader is highly-collaborative and provides both the strategic vision...evolve the business, + Participate in sales calls and lead the delivery of the value propositions, + Educate… more
- Molina Healthcare (Atlanta, GA)
- …facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Grifols Shared Services North America, Inc (Atlanta, GA)
- …connect them with the customer as appropriate + Possess an understanding of the Managed Care landscape and when to utilize necessary internal resources to assist ... and functions including Territory Sales Representatives, Regional Sales Directors, Managed Markets, the Product Brand Team and other necessary stakeholders.… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Degree and Three (3) years of previous related healthcare experience in Healthcare Managed Care , Revenue Cycle/Revenue Integrity or Finance, focused in one or ... and Skills:** + The ideal candidate is a self-motivated leader who possesses healthcare business knowledge and technical aptitude....more of the following areas: Managed Care Contracting, Hospital Reimbursement, Professional Reimbursement,… more
