- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Molina Healthcare (Atlanta, GA)
- …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
- Molina Healthcare (Atlanta, GA)
- …while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective ... psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health /chemical dependency… more
- Elevance Health (Atlanta, GA)
- …abuse cases preferred. **Preferred Skills, Capabilities and Experiences:** + Experience in behavioral health utilization management is highly ... Behavioral Health Care Manager I- ... Behavioral Health Care Manager I- Behavioral ...there is licensed staff supervision. Previous experience in case management / utilization management with a broad… 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
- Highmark Health (Atlanta, GA)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Atlanta, GA)
- ** Behavioral Health Care Manager I (3rd Shift - After Hours)** **Virtual:** This role enables associates to work virtually full-time, except for required ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad… more
- Elevance Health (Atlanta, GA)
- ** Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The ** Behavioral Health Medical Director-Psychiatrist Appeals** is responsible for the… more
- Elevance Health (Atlanta, GA)
- ** Behavioral Health - Care Manager II** **Location:** _Virtual:_ This role enables associate to work virtually full-time, with the exception of required ... an accommodation is granted as required by law. The ** Behavioral Health - Care Manager II** is...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Elevance Health (Atlanta, GA)
- …for employment, unless an accommodation is granted as required by law._ The Behavioral Health Care Manager I is responsible for managing psychiatric and ... + MA/MS in social work counseling or a related behavioral health field or a degree in...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… 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
- Molina Healthcare (Atlanta, GA)
- …or more of the following areas: utilization management , care management , care transitions, behavioral health , or equivalent combination of relevant ... Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. * Leadership experience. *… more
- Elevance Health (Atlanta, GA)
- …Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity. ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member... management . + Partners with Provider Relations, Quality Management , Health Promotions, and Community Relations to… more
- Highmark Health (Atlanta, GA)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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
- Highmark Health (Atlanta, GA)
- …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Atlanta, GA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… 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...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Atlanta, GA)
- …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more