- Molina Healthcare (Augusta, GA)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Molina Healthcare (Augusta, GA)
- …to standardize policies and procedures. + Recruits, hires, trains, mentors, and develops medical director staff and team members as needed. + Ensures ... behavioral health and at least 3 years as a medical director in a managed care setting...management policies across health plans or navigating varied state Medicaid/ Medicare regulations. + Working knowledge of national, state, and… more
- Molina Healthcare (Augusta, GA)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Gentiva (Augusta, GA)
- …Patient Care Manager Specialist to join our team, reporting to the Regional Director of Operational Excellence. This critical role is responsible for managing and ... visit requests based on clinical priorities + Triage phone inquiries and medical concerns within scope of practice + Facilitate Interdisciplinary Group (IDG)… more
- Gentiva (Martinez, GA)
- …Care Manager to join our hospice team. Reporting directly to the Executive Director or Administrator, you will oversee patient care activities to ensure the delivery ... based on clinical judgment and priority + T riage incoming phone referrals and medical concerns in a timely, compassionate, and professional manner + L ead or… more