- WTW (Atlanta, GA)
- …Wealth and Career and Risk and Broking. The Managed Care Growth Leader is the primary client lead managing the totality of the Willis Towers Watson ... (WTW) relationship for clients within the Managed Care Industry. This individual is accountable...business while managing existing revenue and profit streams + Lead the development and execution of client account plans… 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
- Elevance Health (Atlanta, GA)
- …as a Case Manager is preferred. + Certification in the American Association of Managed Care Nurses preferred. + Broad clinical knowledge base of disease ... processes strongly preferred. + Prior managed care and case management experience preferred....is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Humana (Atlanta, GA)
- … - Benefits is an experienced healthcare strategist that possesses broad Medicaid Managed Care expertise, deep working knowledge of insurance products, and has ... track record of bringing new benefits to market. The Lead will partner across various multi-disciplinary teams at Humana...on Medicaid populations + Deep working knowledge of Medicaid managed care policy, programs, and covered services… 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
- Molina Healthcare (Atlanta, GA)
- …and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 8+ years of Medicaid managed care experience or in an equivalent related field * Ability ... with Medicaid Proposals and/or business development and requires demonstrated Medicaid managed care experience comprised of technical operational, sales, growth,… more
- Elevance Health (Atlanta, GA)
- …acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. Please be ... The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Atlanta, GA)
- …acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. For candidates ... The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Molina Healthcare (Atlanta, GA)
- …and evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PR** **E** **FE** **R** **RED L** ... 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
- 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
- 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
- Cardinal Health (Atlanta, GA)
- …organizational development, and possesses a deep understanding of healthcare reimbursement ( managed care and specialty pharmacy operations). In addition to ... Strong project management skills + Understanding of the healthcare reimbursement and managed care + Excellent planning, budget forecasting, and presentation… 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
- Elevance Health (Atlanta, GA)
- …**Minimum** **Requirements:** + Requires BA/BS in Pharmacy. + Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work ... Medicare and Commercial providers strongly preferred. + PBM or Managed Care experience highly desired. Unless expressly...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… 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
- CenterWell (Atlanta, GA)
- … and outcomes + Understanding of health plan frameworks in Medicare Advantage and managed care that affect patient care and population management, such ... & experienced physician leader committed to the principles of comprehensive primary care and unlocking the power of value-based care for patients at national… more
- Molina Healthcare (Atlanta, GA)
- …Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS ... for business data issues as assigned by the team lead . + Analyze data sets and trends for anomalies,...cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional… more
- Molina Healthcare (Atlanta, GA)
- …or equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or ... level (or higher) **Preferred Education** Bachelor's Degree **Preferred Experience** + 5+ years managed care experience + QNXT + Crystal Reports for data… more
- Molina Healthcare (Atlanta, GA)
- …* 3 years' experience in Utilization/Quality Program Management * 2+ years HMO/ Managed Care experience * Experience demonstrating strong management and ... dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization… more