- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Zurich NA (Atlanta, GA)
- …public company Director 's and Officer's (D&O), Fiduciary and transactional risk claims of moderate to high value and complexity. The ideal candidate will have ... Legal Claims Professional - Public D&O 119736 At Zurich...AM - Addison, AM - Atlanta, AM - Parsippany Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered:… more
- Merck (Atlanta, GA)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific Congress Support, and… more
- EPAM Systems (Atlanta, GA)
- **This Remote Position Cannot be Performed in New York City.** You are a natural leader and a proven operator at the most senior levels of clients in the insurance ... - go-to-market, sales, engagement delivery and practice development. As a **Managing Director - Insurance Advisory** , you will lead the demand generation, pursuit,… more
- Prime Therapeutics (Atlanta, GA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Director Account Management, PACE - Remote **Job Description** + Owns overall ... Management Centers (CMC) and Shared Services, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis… more
- Merck (Atlanta, GA)
- …collaboration to further differentiate our portfolio. The Oncology Regional Medical Scientific Director , RMSD, is a credentialed (ie, MD, PhD, or PharmD) therapeutic ... external medical and scientific community. Scientific exchange does not include promotional claims about any drug, vaccine or biologic product. RMSDs provide to… more
- Takeda Pharmaceuticals (Atlanta, GA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- Two95 International Inc. (Atlanta, GA)
- Job Title: Director , Health Plan Analytics Job type : Remote Work Type : 6+ Months Contract with extension Rate : $Market /Hour Requirements Position Summary: As ... the Director of Analytics, you will lead a team of...including but not limited to enrollment, finance, call center, claims , Case Management and Utilization Management * 5+ years… more
- Molina Healthcare (Atlanta, GA)
- …and other end users for operational and strategic analysis. **Knowledge/Skills/Abilities** The Director of Reporting & Analytics is a key leader within the ... BI_** + **_Clinic Systems experience - CCA_** + **_Experience with CM, UM, Claims , or Authorizations_** To all current Molina employees: If you are interested in… more
- Molina Healthcare (Atlanta, GA)
- …* Proficiency in Microsoft Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, ... MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting… more
- United Therapeutics (Atlanta, GA)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- Devereux Advanced Behavioral Health (Kennesaw, GA)
- …and behavioral health challenges. Under the direction of the People Operations Director , you will perform tasks to support the effective and efficient delivery ... Office Applications and database management. + Experience processing worker's compensation claims , FMLA, and other leave of absence cases. + Excellent communication… more
- Humana (Atlanta, GA)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Western Digital (Atlanta, GA)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... requirements. + Insure the proper and efficient handling of claims as they relate to workers' compensation insurance requirements....to be performed in California, Colorado, New York or remote jobs that can be performed in California, Colorado… more
- HomeSafe Alliance (Atlanta, GA)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Celestica (Atlanta, GA)
- …ID: 124191 Region: Americas Country: USA State/Province: New Hampshire City: Remote Employee US **General Overview** **Functional Area:** Supply Chain Management ... (SCM) **Career Stream:** Supply Chain Management (SCM) **Role:** Director 1 (DR1) **Job Title:** Director , Strategic...ensure capacity is installed as needed. + Supports E&O claims , shortage management and follow up escalations with customers… more
- Prime Therapeutics (Atlanta, GA)
- …drives every decision we make. **Job Posting Title** Pricing Analyst - Remote **Job Description** The Pricing Analyst maintains, provides analyses, consults and ... with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness &… more
- Prime Therapeutics (Atlanta, GA)
- …**Job Posting Title** PBM Sr Business Intelligence Data Visual Consultant - Remote **Job Description** The Senior Data Visualization Consultant is responsible for ... new product development. **Responsibilities** + Analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to… more
- Prime Therapeutics (Atlanta, GA)
- …we make. **Job Posting Title** Sr. Pricing Analyst - Pharmacy Network - Remote **Job Description** The Senior Pricing Analyst participates in the assessment of value ... revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other...to adjust focus **Reporting Structure** + Reports to Manager, Director , or Senior Director in the Network… more
- Mathematica (Atlanta, GA)
- …data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through… more