- Humana (Atlanta, GA)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- The Cigna Group (Atlanta, GA)
- …collaborative organization (which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment ... & Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider… 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 ... and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team. Responsible for managing current … 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)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CVS Health (Atlanta, GA)
- …opportunity for a Medical Director ( Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs....is a remote based from from home role. The Medical Affairs department provides clinical business support… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CenterWell (Stone Mountain, GA)
- …clinic hours for a percentage of FTE as determined with Regional Medical Director , as detailed on the clinical job description. + Serve as a community ... community and help us put health first** The Associate Medical Director serves as a health-care professional...clinical providers designated to their area. Keeps a medical history and medical records. Refers the… more
- CVS Health (Atlanta, GA)
- …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... leader in serving dual eligible populations by utilizing best-in-class operating and clinical models in both our Dually Eligible Special Needs Plan (DSNP) and… more
- Humana (Atlanta, GA)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, … 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
- Emory Healthcare/Emory University (Atlanta, GA)
- …Center (ETC) and its programs remain compliant with Centers for Medicare and Medicaid Services (CMS), Organ Procurement and Transplantation Network (OPTN)/United ... of all regulatory agency Requests for Information (RFI) for clinical approvals of the programs including but not limited...and communicates any new requirement concerns to ETCs Executive Director (s) and Sr. Vice President. + Collaborates with ETC… more
- HealthEdge Software Inc (Atlanta, GA)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of ... them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other… more
- Elevance Health (Atlanta, GA)
- ** Director I Compliance - Privacy** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of ... our Elevance Health PulsePoint locations. The ** Director I Compliance** is responsible for directing compliance/implementation of privacy initiatives. **How You Will… more
- Cardinal Health (Atlanta, GA)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… 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 (Stockbridge, GA)
- …you to sit on-site at our Stockbridge, GA branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. This role is a focused on both...final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more
- Evolent Health (Atlanta, GA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... rationale for standard and expedited appeals. + Utilizes medical / clinical review guidelines and parameters to assure...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… 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 ... as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more