- Humana (Atlanta, GA)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources,… more
- Humana (Atlanta, GA)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources… more
- Humana (Atlanta, GA)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources… more
- Molina Healthcare (GA)
- …3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice . + Current clinical knowledge. + Experience ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to the… more
- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical leadership team, providing ... timely medical review of service requests. Oversees the Surgery Field Medical...+ Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of… more
- Evolent (Atlanta, GA)
- …within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology to… more
- CBRE (Atlanta, GA)
- VAS - Quality & Risk Management Director (Institutional/Funds) Job ID 197526 Posted 01-May-2025 Service line Advisory Segment Role type Full-time Areas of Interest ... Role:** As a CBRE Quality & Risk Management (QRM) Director , you will serve as the subject matter expert...incoming Risk Assessments (RA) and participate in the valuation review process, ensuring all valuations issued are of a… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. ... calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Provides clinical rationale for standard… more
- Evolent (Atlanta, GA)
- …within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the...and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Atlanta, GA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Physical Medicine and Rehab you will be a key member of the utilization ... calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard… more
- Evolent (Atlanta, GA)
- …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 ... calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard… more
- Prime Therapeutics (Atlanta, GA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Director Business Portfolio and Solution Architecture - Remote **Job Description** The ... Director of Business Portfolio and Solution Architecture is responsible...initiatives. **Responsibilities** + Set business portfolio and solution architecture practice vision and direction in coordination with business and… more
- Sumitomo Pharma (Atlanta, GA)
- …a dynamic, highly motivated and experienced individual for the position of ** Director ** , **Corporate Counsel, IP.** **Job Duties and Responsibilities** + In ... and biologics. + Advise on portfolio exclusivity positions from patent and regulatory law considerations. + Support global IP litigations including US Hatch-Waxman… more
- AdventHealth (Calhoun, GA)
- …large metropolitan areas: Atlanta and Chattanooga **The role you'll contribute:** The Director of Mission and Ministry is a clinically trained minister, responsible ... needs of patients and providing appropriate interventions to meet such needs. The Director , in conjunction with the Executive Director and/or AVP for Mission… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Center/Emory Heart and Vascular Proposed Academic Appointment: Professor (Proposed pending review ); Surgical Director of Heart Transplantation Primary Role & ... Service as a Cardiothoracic Surgeon with an active clinical practice within the Emory Transplant Center and Emory Heart...and Vascular . Oversight, in conjunction with the Medical Director of Heart Transplantation, of the regulatory … more
- Evolent (Atlanta, GA)
- …the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in **Performance Suite ... and expedited appeals,** ensuring compliance with UM policies and regulatory requirements. + Collaborate with cross-functional teams, including **clinical reviewers,… more
- Revel CPA (GA)
- …in its entirety. You ensure we deliver what we promise and review their business to identify opportunities and strategic recommendations. You're deeply connected ... Proactively staying on top of accounting rule updates and regulatory shifts, applying these changes to our business in...And you've used some project management, task management, or practice management tool, so keeping track of your upcoming… more
- PruittHealth (Atlanta, GA)
- …teams and, as appropriate for center teams. Participates in survey preparation calls, regulatory review calls and survey support activities and provides support ... RESPONSIBILITIES:** * Annually in collaboration with the region/division team, administrator, director of nursing and other key center leaders formulates operation… more
- CenterWell (Decatur, GA)
- …caring community and help us put health first** Reports To: Associate Director , Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours ... + Monitors cases to ensure documentation is following compliance with regulatory agencies and requirements of third-party payers. Ensures final audits/billing are… more