Utilization Review Clinician
2 weeks ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Candidates must have a GA independent licensure (LCSW, LMHC, LPC, LMFT, LMHP, RN). Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria Analyzes BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services Provides education to members and their families regrading ABA and BH utilization process Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master’s degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Board Certified Behavior Analyst (BCBA) preferred Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Utilization Review Clinician
2 weeks ago
Atlanta, United States Centene Corporation Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Candidates must have a GA independent licensure (LCSW, LMHC, LPC, LMFT, LMHP,...
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Clinician - Inspire Georgia
2 weeks ago
Atlanta, United States INSPIRITUS INC Full timeJob DetailsJob Location Atlanta - Atlanta, GA Position Type Full Time Education Level Graduate Degree Travel Percentage Up to 25% Job Shift Day Job Category Nonprofit - Social Services Description[Bilingual Strongly Preferred]ClinicianInspire Georgia The Clinician is responsible for conducting behavioral health assessments and providing ongoing clinical...
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Clinician - Inspire Georgia
2 months ago
Atlanta, United States INSPIRITUS INC Full timeJob DetailsJob Location Atlanta - Atlanta, GA Position Type Full Time Education Level Graduate Degree Travel Percentage Up to 25% Job Shift Day Job Category Nonprofit - Social Services Description[Bilingual Strongly Preferred]ClinicianInspire Georgia The Clinician is responsible for conducting behavioral health assessments and providing ongoing clinical...
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Clinician - Inspire Georgia
1 month ago
Atlanta, United States INSPIRITUS INC Full timeJob DetailsJob LocationAtlanta - Atlanta, GAPosition TypeFull TimeEducation LevelGraduate DegreeTravel PercentageUp to 25%Job ShiftDayJob CategoryNonprofit - Social ServicesDescription[Bilingual Strongly Preferred]ClinicianInspire GeorgiaThe Clinician is responsible for conducting behavioral health assessments and providing ongoing clinical services to...
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Clinician
2 weeks ago
Atlanta, United States Jewish Family & Career Service Full timeJob Type Full-time Description Jewish Family & Career Services of Atlanta (JF&CS) offers best-in-class, person-centered programs and resources to transform lives. Building on our 125-year history, we are here to help individuals and families of all faiths live to their full potential. Guided by Jewish values, we are a welcoming community , and our...
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Medical ICU Clinician
7 days ago
Atlanta, Georgia, United States Emory Healthcare Full timeWe are seeking a skilled and experienced Registered Nurse to join our team at Emory Healthcare. As a capable clinician, you will be responsible for delivering high-quality patient care in the Medical ICU, utilizing your expertise to personalize treatment plans, and collaborating with interdisciplinary teams to achieve optimal patient...
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Head and Neck Nurse Clinician
2 weeks ago
Atlanta, Georgia, United States Emory Healthcare Full timeAbout the RoleThis full-time position offers a competitive salary and a comprehensive benefits package, including health insurance, retirement savings plan, paid time off, and more.As a Head and Neck Nurse Clinician, you will work closely with patients and their families to develop personalized care plans, utilize the Synergy Model for Care, and promote...
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Utilization Management Professional
1 week ago
Atlanta, Georgia, United States Sonder Health Plans Full timeKey ResponsibilitiesThis Utilization Management Nurse will be responsible for determining the appropriateness of inpatient and outpatient services based on medical guidelines and benefit determinations. Additionally, they will identify and report any quality of care concerns during acute care or skilled nursing facility stays.The successful candidate will...
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Senior Mental Health Clinician for Older Adults
2 weeks ago
Atlanta, Georgia, United States Jewish Family & Career Services Full timeThe Jewish Family & Career Services of Atlanta seeks a highly skilled and compassionate clinician to join our team as a Senior Mental Health Clinician for Older Adults. This is a full-time position that requires excellent clinical skills, strong communication abilities, and a passion for working with older adults.About the Job:As a Senior Mental Health...
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Plan Review Specialist, Senior Zoning Official
4 weeks ago
Atlanta, Georgia, United States City of Atlanta Full timeJob OverviewWe are seeking a highly skilled Plan Review Specialist to join our team in the City of Atlanta. As a key member of our zoning department, you will play a critical role in ensuring compliance with regulatory zoning codes, ordinances, and laws.About the RoleThis is a challenging and rewarding opportunity for an experienced professional to utilize...
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Nurse Clinician Emergency Services
3 weeks ago
Atlanta, Georgia, United States Emory Healthcare Full timeAbout the OpportunityWe are excited to offer this unique opportunity for a Nurse Clinician Emergency Services to join our team at Emory Healthcare. This role offers an exciting chance to work in a fast-paced environment, collaborating with interdisciplinary teams to deliver comprehensive care to patients and their families.ResponsibilitiesProvide...
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RN - Utilization Management, PRN
1 month ago
Atlanta, United States Piedmont Healthcare Full timeDescription:RESPONSIBLE FOR: The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures...
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Atlanta, Georgia, United States Humana Full timeWe are seeking an experienced UM Administration Coordinator 2 to join our team at Humana. This role involves providing administrative support to prioritize health and wellness, ensuring the delivery of high-quality treatment, care, or services to our members.About the PositionThe UM Administration Coordinator 2 will perform a range of administrative tasks,...
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Behavioral Health Clinician
2 days ago
Atlanta, United States Apree Health Full timeDescription Behavioral Health Clinician Position Summary: Vera's clinic model and atmosphere were created to support practitioners who desire to focus on patient care first, encouraging both patient and practitioner to have quality time together during visits to empower patients using empathetic listening to actively participate in their own wellness...
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Medical Professional
1 month ago
Atlanta, Georgia, United States Emory Health Care Full timeJob OverviewWe are seeking a skilled Medical Professional to join our team as an Ambulatory Care Clinician. This role involves delivering high-quality patient care in a fast-paced environment.About Emory HealthcareEmory Healthcare is a leading academic health system in Georgia, comprising 11 hospitals and over 425 provider locations. We offer a comprehensive...
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Senior Utility Billing Specialist
4 weeks ago
Atlanta, Georgia, United States Yardi Systems Full timeAbout Yardi SystemsYardi pioneers the property tech industry by seamlessly blending 40 years of tradition with forward-thinking innovation. We've created a team of over 9,000 employees in more than 40 locations around the globe dedicated to making great real estate software products.Our MissionWe're on the hunt for individuals who bring together technical...
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Medical Case Manager
1 month ago
Atlanta, Georgia, United States Kaiser Permanente Full timeAbout the JobKaiser Permanente is seeking a skilled Medical Case Manager to join our team. As a key member of our healthcare team, you will work collaboratively with physicians and other healthcare professionals to optimize quality and efficiency of care for hospitalized members.Job SummaryThis position is responsible for carrying out daily utilization and...
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Managed Review Project Manager
2 months ago
Atlanta, United States TransPerfect Full timeWho We Are:TransPerfect is the world's largest provider of language services and technology solutions for global business. From offices in over 100 cities on six continents, TransPerfect offers a full range of services in 170+ languages to clients worldwide. More than 5,000 global organizations employ TransPerfect's GlobalLink® technology to simplify...
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Managed Review Project Manager
2 months ago
atlanta, United States TransPerfect Full timeWho We Are:TransPerfect is the world's largest provider of language services and technology solutions for global business. From offices in over 100 cities on six continents, TransPerfect offers a full range of services in 170+ languages to clients worldwide. More than 5,000 global organizations employ TransPerfect's GlobalLink® technology to simplify...
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Plan Review Specialist, Sr
2 months ago
Atlanta, United States City of Atlanta Full timeAt the City of Atlanta, we are passionate about building and improving our community. Our police officers, firefighters and building inspectors keep our citizens safe. Our Public Works staff keeps our City clean and helps maintain, build and improve our City’s infrastructure. Our City planners help envision and shape future City growth. Our Parks &...