- 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Atlanta, GA)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) 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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Atlanta, GA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Humana (Atlanta, GA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Atlanta, GA)
- …and related tasks; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business ... community and help us put health first** The Corporate Medical Director (CMD) relies on medical...+ Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about… more
- Evolent (Atlanta, GA)
- …for 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 . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Molina Healthcare (Atlanta, GA)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Medical License without restrictions (free of sanctions from Medicaid or Medicare) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health,… more
- Evolent (Atlanta, GA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Danaher Corporation (Atlanta, GA)
- …that improve patient outcomes across a range of settings. As a member of our team , you can make an immediate, measurable impact on a global scale, within an ... the Danaher Business System which makes everything possible. The Field Reimbursement Director position is a provider / customer facing role responsible for… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Internal Audit Director is a critical leadership role responsible for developing, implementing, and overseeing the internal audit ... ensure the successful delivery of high-quality audit results across the company. The Director will work closely with executive leadership and the Audit Committee to… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Associate Director , Business Intelligence solves complex business problems and issues using data from ... external sources to provide insight to decision-makers. The Associate Director , Business Intelligence requires a solid understanding of how...applications, and data resources. The role will lead a team of up to approx. 7-9 direct associates. **Key… more
- Gentiva (Atlanta, GA)
- …leadership ensures compassionate care reaches every patient, every day. As an Executive Director Specialist - RN, you'll serve as the operational and clinical leader ... with all federal, state, and organizational standards. **What You'll Do as Executive Director Specialist - RN:** + Serve as the Administrator on record at assigned… more
- Baylor Scott & White Health (Atlanta, GA)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare/ Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the..., Denial Resource Center will lead a highly skilled team of Registered Nurses, Certified Coding Specialists, Complex Appeal… more
- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Associate Director of DevOps Engineering is a strategic and technical leadership role responsible for ... guiding our DevOps initiatives. You will lead a team of talented DevOps engineers, focusing on standardization, building partnerships with software delivery teams to… more
- CVS Health (Atlanta, GA)
- …a team of actuaries responsible for supporting the IVL MA actuarial team , local market partners, and Medicaid partners to provide a best-in-class bid ... all Aetna geographies, Medicare Advantage market actuaries, and associated Medicaid actuaries. Establish best practices, ensure consistency, and provide guidance… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Director , Clinical and Revenue Integrity Operations is responsible for the oversight and management of our team of Revenue Integrity ... leader will ensure appropriate staffing, goal setting and performance management of the team . It is expected that this leader is highly comfortable and highly… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Director of Security Operations is a security leadership position that will manage the Joint Security Operations and Identity Management ... teams/processes. The Security Operations team is responsible for conducting 24x7 monitoring and response....systems, and is connected to over 5K commercial and Medicaid /Medicare payers. We are deeply committed to living out… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** We are seeking an experienced and strategic Director of Accounting - Billing & Collections to lead our billing operations and receivables ... deep expertise in financial operations, customer invoicing, revenue assurance, and team leadership. **WHAT YOU'LL DO** **Leadership & Strategy:** + Lead, develop,… more