- Insmed Incorporated (Atlanta, GA)
- …of the field-based Field Access team, and will report to the Director , Field Access Managers. This is a non-supervisory position.ResponsibilitiesA key component of ... launch experience preferred Experience navigating payer reimbursement process, preferably Medicare Part D (pharmacy benefit design and coverage policy) Experience… more
- Elevance Health (Atlanta, GA)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will **must live** within 50 miles of ... one of our Elevance Health PulsePoint locations. The ** Medicare Medical Director ** is responsible for the administration of physical and/or behavioral health… more
- Humana (Atlanta, GA)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Atlanta, GA)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
- Trinity Health (Atlanta, GA)
- …follow up on overdue accounts and rejected claims. + Notify the Department Director or Manager as necessary regarding billing and claim processing. + Facilitate ... staff. + Maintain the integrity and confidentiality of patient financial and medical records. + Perform General Ledger Accounting duties, including journal entry and… more
- Elevance Health (Atlanta, GA)
- …objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and ... **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not limited… more
- The Cigna Group (Atlanta, GA)
- …& Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider ... All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: **Growing the MA… 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 home ... home health per diem, DME, and waiver requests. The Medical Director provides medical interpretation... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … 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 ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… 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
- 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
- Evolent Health (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Atlanta, GA)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for… more
- Aveanna (Atlanta, GA)
- …to Medicare and Medicaid provider numbers * Assist Location Director , CNO/Compliance Department with information necessary to comply with state audits and/or ... Director , Regulatory Licensing ApplyRefer a FriendBack Job Details...achieving results. Responsible and leads key projects related to licensing/ Medicare /Medicaid processes, adverse sanctions, and disclosures of ownership related… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Director , Provider Contracting, leads and manages the provider networks for all of Humana's various ... lines of business through the NC Contracting team. The Director also initiates, analyzes, and negotiates hospital, physician, and/or other provider contracts and… more
- Humana (Atlanta, GA)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Humana (Atlanta, GA)
- …and help us put health first** The Clinical Pharmacy Provider Engagement Associate Director , HPS Clinical Program Strategy, partners with Medicare Leadership to ... in-depth understanding of how organization capabilities interrelate across the PBM, Medicare segment, and provider organizations. The effective candidate must have… more
- Humana (Atlanta, GA)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Prime Therapeutics (Atlanta, GA)
- …passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary** ... Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team. Responsible for… more
