- 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
- CVS Health (Atlanta, GA)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...Board Certified in ABMS Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- CVS Health (Atlanta, GA)
- …implementation of large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare ... the formulation, implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and… 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)
- **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)
- … 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 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs....need a Board Certified Oncologist for this opportunity. 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)
- …clinical 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
- 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
- CVS Health (Atlanta, GA)
- …and behavioral health programs and services to its membership. Aetna is looking for a medical director to be part of a centralized team that supports the ... members and providers related to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located anywhere in the… 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
- 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 ... patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the… 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
- 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
- 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