- CVS Health (Atlanta, GA)
- …in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both provider and ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Atlanta, GA)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Atlanta, GA)
- ** Director I Medicare Operations** **Location:** This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one ... Medicare and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations** is responsible for directing multiple business… more
- CVS Health (Atlanta, GA)
- …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs....medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs… 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 ... 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
- CVS Health (Atlanta, GA)
- …will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) Experience with managed care ( Medicare… 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 ... in both our Dually Eligible Special Needs Plan (DSNP) and our Medicare -Medicaid Plan (MMP) programs. We collaborate with members, providers, and community… more
- CVS Health (Atlanta, GA)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... and services for aligned plan's members. Position Description: Aetna Medicare Duals Center of Excellence is searching for a...the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider… 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 ... member of the utilization management team, and provides timely medical review of service requests that do not initially...fax. + Provides clinical rationale for standard and expedited appeals . + Provides assistance and act as a resource… more