- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- CenterWell (Marietta, GA)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- CenterWell (Atlanta, GA)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...May perform work associated with patient care assignments and staff management activities. + Acts as Branch… more
- Highmark Health (Atlanta, GA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- State of Georgia (Dekalb County, GA)
- … Clinical Manager. + Assists in managing social service personnel, including staff coverage, through collaboration with the Clinical Manager. + Demonstrates ... Actively support agency goals and Clinical Manager. + Work in conjunction with Clinical Manager to inspire staff to adhere to policy and procedure. SKILL,… more
- Fresenius Medical Center (Atlanta, GA)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- Morehouse School Of Medicine (Atlanta, GA)
- …* Staff competency completion, certification rates, and system utilization discipline. Reporting Structure Reports to: Director, Clinical Research ... departments and faculty, and Institutional Compliance/Privacy. SUPERVISORY RESPONSIBILITIES : Clinical Trials staff Pre-Employment/Employment Requirements All offers… more
- Humana (Atlanta, GA)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Emory Healthcare/Emory University (Decatur, GA)
- …use. + Facilitate quarterly collaboration with facilities and nursing faculty to align clinical utilization to ensure placement needs are met. + Conduct site ... The School of Nursing is looking for a highly organized and relationship-focused Clinical Placement Coordinator to join our team at theEmory Nursing Learning Center… more
- Wider Circle (Atlanta, GA)
- …scheduling, escalation protocols, documentation standards, and QA. + Own coordination between clinical staff , product, and data teams. + Step into operational ... and empathy. Requirements What You'll Bring + 5-8 years of experience in clinical operations, care management , or tech-enabled care - ideally in digital… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Prime Therapeutics (Atlanta, GA)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Molina Healthcare (Atlanta, GA)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... work of external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative to business needs.… more
- Battelle Memorial Institute (Atlanta, GA)
- …with Battelle/CDC policies as they relate to time, attendance, and safety. + Conduct Management Safety Observations (MSOs) with all staff on an annual basis. + ... leader in science and technology research. Drug Development and Clinical Programs (DDCP) is a part of the Life...will support positive programs for equal treatment of all staff and full utilization of all qualified… more
- Evolent (Atlanta, GA)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Atlanta, GA)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Atlanta, GA)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Molina Healthcare (Atlanta, 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
- Elevance Health (Atlanta, GA)
- …expert consultation to local plan staff on benefits interpretation and utilization and quality management matters. + Ensures support for compliance with ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member...health care field and a minimum of 10 years clinical work experience including prior management experience;… more