- Elevance Health (Atlanta, GA)
- ** Medical Director - Appeals ( Primary Care-IM or FM)** **Location: This is a hybrid position. Candidates must live within 50 miles of an Elevance Health ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Evolent Health (Atlanta, GA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into… more
- CVS Health (Atlanta, GA)
- …coverage and policies. ** Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... directors to ensure the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider education regarding best… more
- Evolent Health (Atlanta, GA)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the utilization management team. ... Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a member of...restrictions. + 3-5 years of clinical practice in a primary care setting and progressively responsible medical … 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 ... new markets across the country. Ability to work CST or EST Preferred. ** Primary Duties and Responsibilities:** * Provides clinical oversight of the Dual Eligible… more
- Elevance Health (Columbus, 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 of ... Medicare and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations** is responsible for directing multiple business function… more
- Highmark Health (Atlanta, GA)
- … Doctor or Doctor of Osteopathic Medicine (DO) + Board certification in a primary medical specialty + Active, unrestricted medical state licensure required. ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Evolent Health (Atlanta, GA)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...support. + On a requested basis, may function as Medical Director for selecting health plans or… 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 ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and… more
- Sharecare, Inc. (Atlanta, GA)
- …cost-effective manner. The Clinical Advocate coordinates with the member, their Primary Care Provider, Specialty Care Providers, ancillary services, and all other ... in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy...providers or members to the Clinical Advocate Manager or Director when he/she identifies an opportunity for education or… more