- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Authorize and review utilization of dental services provided in provider ... a resource between the health plan, provider relations, and dental providers + Review treatment plans and...of Georgia + 3+ years of Utilization Management or Clinical Experience in a Dental … more
- Actalent (Atlanta, GA)
- Utilization Review (Registered Nurse) Job Description...GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of ... care. Additional Skills & Qualifications + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job Type & Location This is… more
- Humana (Atlanta, GA)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time… more
- Elevance Health (Atlanta, GA)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... ** Utilization Management Medical Director- NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Cognizant (Atlanta, GA)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Atlanta, GA)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- CenterWell (Atlanta, GA)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... - unrestricted + Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus + Previous Medicare… more
- Highmark Health (Atlanta, GA)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... internally and externally (providers, dental industry, organized dentistry and dental consultants) keeping management informed on related healthcare industry… more
- Stantec (Atlanta, GA)
- …Your Opportunity The Commissioning Analyst performs basic technical and project management duties under the supervision of a Senior Commissioning Authority or ... intent and scope of work outlined in proposals. - Follows the quality management process; reviews project deliverables prior to submission to QA/AC reviewer .… more
- Guardian Life (Atlanta, GA)
- …re-credentialing activities, and reviewing with the group any identified outlier utilization patterns. You are An experienced dental network ... of Guardian's network through developing partnerships and providing outstanding service to Dental Support Organization (DSO) partners. As a **Key DSO Dental … more
- Cardinal Health (Atlanta, GA)
- **_What IT Software Supplier Management contributes to Cardinal Health_** IT Software Supplier Management provides strategic support and management of ... procurement (IDP), solution owners, enterprise architecture, finance, and software vendor management to mitigate commercial and legal risks and minimize the impact… more
- CRC Insurance Services, Inc. (Alpharetta, GA)
- …English (Required) **Work Shift:** 1st Shift (United States of America) **Please review the following job description:** The Asset & Configuration Management ... compliance, cost control, and process improvements. The Asset & Configuration Management Lead will collaborate with IT, finance, procurement, and security teams… more
- Ryder System (Atlanta, GA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : BUILD ON YOUR ... we've been in the game since 1933! The **Operations Management Trainee** ( **OMT** ) is an 18 to...+ Coordinate with the rental department to ensure maximum utilization without compromising lease customers + Partner with Sales… more
- CBRE (Atlanta, GA)
- …action and termination. Effectively recommends same for direct reports to next level management for review and approval. + Monitors appropriate staffing levels ... Data Center Design and Engineering Team Lead - Project Management Senior Director Job ID 246110 Posted 07-Nov-2025 Service...and reports on utilization and deployment of human resources. Leads and supports… more
- Concentrix (Atlanta, GA)
- Job Title: Director, Account Management Job Description Director, Account Management , Mobility Sector We're Concentrix. The intelligent transformation partner - ... at the CXO level. Experience in the Mobility Sector and account management , especially with large, complex global clients, is recommended. Significant international… more
- CenterWell (Marietta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...care analysis to determine efficiency, the efficacy of case management system as well as any other systems and… more
- Humana (Atlanta, GA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Atlanta, GA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Elevance Health (Atlanta, GA)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually… more
- Highmark Health (Atlanta, GA)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding,...in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the… more