- CVS Health (Atlanta, GA)
- … clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Guidehouse (Atlanta, GA)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and operational improvement across business and purchased services, supply cost, and clinical supply utilization at client provider organizations. Our team of… more
- Guidehouse (Atlanta, GA)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and operational improvement across business and purchased services, supply cost, and clinical supply utilization at client provider organizations. Our team of… more
- Cardinal Health (Atlanta, GA)
- **Ideal candidate will live near a major/regional airport.** **_What Clinical Operations contributes to Cardinal Health_** Clinical Operations is responsible for ... and service education to facilitate technology adoption and workflow change management . + Demonstrates extensive knowledge and understanding of relevant clinical… more
- Elevance Health (Atlanta, GA)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be… more
- Highmark Health (Atlanta, GA)
- …needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, ... while also being capable of developing technical solutions. The consultant will act as a senior resource within the...the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The… more
- CenterWell (Atlanta, GA)
- …on wellness, prevention, and early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well ... management + Providing direct education to clinicians around clinical protocols / disease + prevalence / appropriate levels...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …a central role in this transition - leading facility design, ensuring effective utilization of clinical spaces, and executing the planned relocation initiative ... basis. This individual is a content expert and internal consultant for physician leadership and clinical faculty,...Management : + Has responsibility for both academic and clinical missions. + Working with Chair and SOM Compensation… more
- Elevance Health (Atlanta, GA)
- …Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May...an entire clinical program and/or independently performs clinical reviews. + Typically has program management … more
- State of Georgia (Dekalb County, GA)
- …interventions to improve the student's disciplinary and academic performance + Serves as clinical consultant for school staff and may assist educators with ... an evidence-based framework within the school environment. Demonstrates strong clinical judgment in assessment, application of diagnostic criteria, clinical… more
- CVS Health (Atlanta, GA)
- …relations; customer service or audit experience. Experience in research and analysis of utilization management systems. *Fluent in Spanish, both oral and written ... accuracy and appropriateness of a benefit/administrative denial. Can review a clinical determination and understand rationale for decision. Able to research claim… more