- Elevance Health (Columbus, GA)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
- Elevance Health (Columbus, GA)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Molina Healthcare (Columbus, GA)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Columbus, GA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Columbus, GA)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management...**REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3… more
- Molina Healthcare (Columbus, GA)
- …closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and ... and clinical leadership for health plan and/or market specific utilization management and care management ...health portions of state contracts. * Assists behavioral health medical director lead trainers in the development… more
- Elevance Health (Columbus, GA)
- ** Medical Director Associate - CarelonRx** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... dispensing services to drive affordability and improve member outcomes. The ** Medical Director Associate- CarelonRx** supports pharmacy prior authorization… more
- Molina Healthcare (Columbus, GA)
- …with operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process ... early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies...+ Research and develop reports and analysis for senior management , effectively presenting and communicating results. + Works closely… more
- Molina Healthcare (Columbus, GA)
- …+ Manage projects spanning multiple domains + Supports Market and Enterprise management and other team members are related to all things financially related ... reserves for appropriateness monthly + Work collaboratively with Actuarial and Medical Economics partners to evaluate correlation among various parameters impacting… more
- Elevance Health (Columbus, GA)
- …required by law. Must have License to practice in the state of Georgia** The ** Medical Management Nurse** is responsible for review of the most complex or ... nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy… more
- Molina Healthcare (Columbus, GA)
- …need. * Offers a positive leadership role in key segment/product medical management initiatives aimed a optimizing utilization of medical resources. * ... and at least 2 years as a medical director in managed care organization supporting utilization management /quality program management , or equivalent… more
- CenterWell (Columbus, GA)
- …caring community and help us put health first** Reports To: Associate Director , Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more