- 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
- 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 ... within the market. Often this includes multi-site health systems and national primary care clinic partners. The Provider Performance Enablement Advisor's… more
- The Cigna Group (Atlanta, GA)
- The Medicare Advantage Market Performance Advisor is cross-functional, collaborative role designed to connect Market Provider Performance Enablement field teams with ... achieve these goals. This position will report to the Performance Operations Director with direct alignment to 2-3 Market Presidents. The Market Performance Advisors… more
- Humana (Atlanta, GA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana… 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 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 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)
- …a part of our caring community and help us put health first** The Associate Medical Director serves as a health-care professional and capable of handling a ... variety of health-related problems. The Associate Medical Director requires a solid understanding of...**Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- CVS Health (Atlanta, GA)
- …transformation, and administrative support. CVS Accountable Care is seeking an Executive Director , Payor Medical Economics to join our growing organization. In ... business, is a strategic partner in value-based care serving more than 1M Medicare beneficiaries, and over 60K provider partners across 230 clients in ACO REACH,… more
- Gilead Sciences, Inc. (Atlanta, GA)
- …the lives of patients with life-threatening illnesses worldwide. As the **Senior Director , Field Reimbursement Management (FRM)** for HIV Prevention, you will play a ... with pharmacy benefits, specialty payer landscape, and reimbursement pathways (commercial, Medicare , Medicaid). + An understanding of local and state policy changes'… more
- Humana (Atlanta, GA)
- …us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management) to lead within a specific ... and project management are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management) will provide oversight to the… 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)
- …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
- Option Care Health (Peachtree Corners, GA)
- …Allergy/Immunology specialties + Understanding of billing and reimbursement procedures for medical offices and hospitals (Commercial Insurance, Medicare Part B ... conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for… more
- Prime Therapeutics (Atlanta, GA)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Director , Technology Solution Implementation delivers new technological solutions to meet business needs ... within a specified scope while aligned to enterprise objectives. The Director , Technology Solution Implementation requires an in-depth understanding of how… more
- Conviva (Atlanta, GA)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more