- Molina Healthcare (Augusta, GA)
- …operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve. ... **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to performance of… more
- Molina Healthcare (Macon, GA)
- …on increased responsibility and adding value to the organization + Ensures strong operational processes are in place to deliver across all areas of responsibility + ... Provides oversight analyses of demographic data to support accurate Network Adequacy Reporting and Directory development. + Manage multiple resources and projects… more
- CenterWell (Atlanta, GA)
- …improvement. + Work collaboratively with the Strategy Advancement and Operations Director to align clinical and operational priorities. **Quality Improvement ... and help us put health first** The National Medical Director for Home-Based Care Programs is a key clinical...skills; ability to collaborate effectively with clinicians, executives, and operational leaders. + Advanced knowledge of Medicare … more
- Molina Healthcare (Macon, GA)
- …to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight , monitoring ... and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's… 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 ... across the organization. The position will be focused on oversight of the entire SOX compliance program (including both...and ITGCs) and may expand to cover risk based operational audits in the future. The ideal candidate should… more
- Baylor Scott & White Health (Atlanta, GA)
- …, Denial Resource Center is responsible for the strategic planning, evaluation, and operational oversight of the clinical denial management function for Baylor ... Scott and White Health (BSWH). The Director , Denial Resource Center will lead a highly skilled...function for BSWH. + Recommends and implements strategic and operational plans and priorities for clinical denial management aligned… more
- Humana (Atlanta, GA)
- …to deliver agile, data-driven, and personalized member experiences at scale. As Director of Marketing Communication Operations, you will play a pivotal leadership ... approaches and compliance with CMS, Medicaid, and Pharmacy marketing standards ** Operational Excellence & Vendor Ecosystem** + Design and implement scalable… 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 ... to be an integral part of ongoing product and operational strategy. Technical and process aptitude is a must....systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out… more
- Molina Healthcare (Columbus, GA)
- …Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of processes that track, evaluate, and submit encounter deletions ... for Medicare Advantage, ACA, and Medicaid lines of business. This...accuracy & completeness (ie, Encounter Production, Audit, Production Vendor Oversight ) for assigned lines of business. Responsible for increasing… more
- STG International (Milledgeville, GA)
- …the effectiveness of those interventions when necessary. *Assist the Medical Director in the development and implementation of medical and nursing services ... reporting of crimes in accordance with federal, state and local guidelines. *Provide oversight for the admission, transfer and discharge of all residents from the… more
- State of Georgia (Gwinnett County, GA)
- …the Director . Manages the planning, development, and implementation of operational support services for a facility. Develops and implements policies and ... disabilities. View Point Health serves uninsured, underinsured, low-income Medicaid, Medicare , war veterans and some private insurance across multiple locations… more
- Molina Healthcare (GA)
- …strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core ... contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight . Tighter knit proximity ongoing after contract. * In conjunction… more
- Molina Healthcare (GA)
- …for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support ... outreach and resolving provider inquiries. + In conjunction with the Director , Provider Network Management & Operations, develops health plan-specific provider… more