- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Elevance Health (Atlanta, GA)
- …role in a managed care environment and possess strong utilization management experience. + ** Behavioral Health & Chemical Dependency:** Substantial ... Behavioral Health offers superior clinical mental health and substance use disorder management , a...GA, Woodland Hills, CA. **Summary** The Behavioral Health Chief Medical Officer oversees Utilization Review,… more
- Humana (Atlanta, GA)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Molina Healthcare (Atlanta, GA)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Elevance Health (Atlanta, GA)
- ** Behavioral Health Care Manager I** **Location:** **Georgia.** Virtual: This role enables associates to work virtually full-time, with the exception of required ... Requires MA/MS in social work counseling or a related behavioral health field or a degree in...admissions experience is preferred. + Previous experience in case management / utilization management with a broad… more
- Molina Healthcare (Atlanta, GA)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Superior Court of Fulton County (Atlanta, GA)
- PART-TIME BEHAVIORAL HEALTH CLINICIAN II **SUPERIOR COURT OF FULTON COUNTY** **JOB ANNOUNCEMENT FOR THE POSITION OF** PART-TIME BEHAVIORAL HEALTH ... Fulton County Georgia ("Court") has an exciting opportunity for an experienced Behavioral Health Clinician II within its Accountability Court's Division.… more
- Superior Court of Fulton County (Atlanta, GA)
- BEHAVIORAL HEALTH CLINICIAN I **SUPERIOR COURT OF FULTON COUNTY** **JOB ANNOUNCEMENT FOR THE POSITION OF** BEHAVIORAL HEALTH CLINICIAN I **_SALARY GRADE ... Fulton County Georgia ("Court") has an exciting opportunity for an experienced Behavioral Health Clinician within its Accountability Courts Division. Superior… more
- CenterWell (Atlanta, GA)
- …engagement, improving provider capacity by reducing administrative work related to population health management , and assisting patients with the aim of improving ... advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management ) + Comfortable managing… more
- Highmark Health (Atlanta, GA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …all case management activities at the local hospital, including utilization management , transitions of care, discharge planning, payer authorization, medical ... what you want to be. We provide: + Comprehensive health benefits that start day 1 + Student Loan...more **Description** We are seeking a capable **Director, Care Management ** who has acquired broad experience in caring for… more
- Highmark Health (Atlanta, GA)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- Elevance Health (Atlanta, GA)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Atlanta, GA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- ChenMed (Decatur, GA)
- …closely with facility-based healthcare providers (post-acute care providers, case, and utilization management departments), strategic payor partners and our ... of stay management and readmission mitigation + Understanding of case and utilization management procedures in post-acute care settings and how to leverage… more
- Highmark Health (Atlanta, GA)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Atlanta, GA)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Atlanta, GA)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more