- 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)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports)...an integrated delivery of care across the continuum, including behavioral health and long-term care, for members… more
- CVS Health (Atlanta, GA)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... 8:30am - 5pm within time zone of residence.** American Health Holding, Inc (AHH) is a medical management...states - 1+ years' current or previous experience in Behavioral Health - 1+ years' experience documenting… 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
- 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
- Highmark Health (Atlanta, GA)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… 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