- 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
- Fresenius Medical Center (Carrollton, GA)
- …as a resource to facility staff . + Provides counseling for all clinical staff members at regular intervals offering support and encouraging professional ... to the disease management company. Maintains current knowledge of disease management software and systems as pertinent. ** STAFF :** + Responsible for… 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
- 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
- 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
- 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
- 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
- Elevance Health (Atlanta, GA)
- …benefits plans will require guidance from leadership, medical directors or delegated clinical staff . + Conducts and may approve pre-certification, concurrent, ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… 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
- 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
- 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
- Parexel (Atlanta, GA)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
- Evolent (Atlanta, GA)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more