- Elevance Health (Atlanta, GA)
- …Health office locations Work schedule: Monday - Friday, standard business hours.** The Medical Director Clinical Programs is responsible for designing and ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...implementing clinical programs with specific medical condition focus for all lines of business enterprise… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- CenterWell (Atlanta, GA)
- …part of our caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic pharmacy leader responsible for developing, ... Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: +...(SME) and clinical liaison to the national clinical leadership (including Chief Medical Officer, Complex… more
- Prime Therapeutics (Atlanta, GA)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all … more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Atlanta, GA)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... consumer experiences and a highly engaged team culture The Medical Director conducts clinical case... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Elevance Health (Atlanta, GA)
- …May be responsible for an entire clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management ... miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration...Director Associates. May be responsible for an entire clinical program. How you will make an impact: +… more
- Elevance Health (Atlanta, GA)
- …May be responsible for an entire clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management ... of one of our Elevance Health office locations.** The Medical Director is responsible for the administration...Director Associates. May be responsible for an entire clinical program. How you will make an impact: +… more
- CenterWell (Atlanta, GA)
- …in Medicare /seniors * Demonstrated ability to work collaboratively with clinical and operational leaders across a complex health care organization. * Knowledge ... a part of our caring community and help us put health first** **National** ** Director of Transitional Care and High-Risk Patient Management** The Director of… more
- VIP Care (Atlanta, GA)
- …environment. Key Responsibilities: + Leadership: + Partner with Regional Managers, Operations and Medical Director for best practices in Regions + Develop and ... teams in a value-based healthcare delivery environment as well as traditional Medicare and commercial payor environments. The Director of Healthcare Operations… more
- Humana (Atlanta, GA)
- …our caring community and help us put health first** The Associate Director of Contractor Workforce Management will drive a best-in-class contractor workforce ... and Direct Sourcing Platforms + MSP management experience + Technical and Clinical Contingent Labor management experience + Excellent analytical skills; ability to… more
- Brookdale Senior Living (Atlanta, GA)
- …each community within district on a scheduled basis and as approved by Division Director of Sales or VP Sales. Partners with on-site sales teams and Executive ... and strategies to achieve and maintain full occupancy. + Interacts with Clinical Operations and other home office associates. Educates and supports these partners… more
- CenterWell (Cumming, GA)
- …requires sitting on-site at our** **Cumming, GA** **branch location.** The ** Clinical Manager** coordinates and oversees all direct care patient services provided ... by clinical personnel....final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more
- Vatica Health (Alpharetta, GA)
- …The Manager of Clinical Operations collaborates with and reports to the Senior Director of Clinical Operations on clinical and non- clinical issues ... in assigned territory. + Work proactively and collaboratively with Senior Director of Clinical Operations, Provider Engagement Representatives, and other… more
- Prime Therapeutics (Atlanta, GA)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... Clinical Reviewers as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure consistency in the MD… more
- Humana (Atlanta, GA)
- …assigned health plan and/or specialty companies relative to Medicare /Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and ... collaborative organization which includes Provider Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment. Reporting… more
- Highmark Health (Atlanta, GA)
- …+ Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to drive ... as an adjunct to health coaching. If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case… more
- CenterWell (Marietta, GA)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... accordance with standards of care. + Follows level of medical care and quality for patients and monitors care...coding specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with RMD about quality of… more