- Elevance Health (Atlanta, GA)
- **Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... as required by law. Alternate locations may be considered. The **Appeals Medical Director ** is responsible for the appeal reviews for physical health medical… more
- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Humana (Atlanta, GA)
- …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 ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Cumming, GA)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Humana (Atlanta, GA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff… 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)
- **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
- 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
- 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 to ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Evolent (Atlanta, GA)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Atlanta, GA)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Highmark Health (Atlanta, GA)
- …**JOB SUMMARY** This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support ... the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. This includes the writing of clinical… 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 ... timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Atlanta, GA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Atlanta, GA)
- …to standardize policies and procedures. + Recruits, hires, trains, mentors, and develops medical director staff and team members as needed. + Ensures ... behavioral health and at least 3 years as a medical director in a managed care setting...management policies across health plans or navigating varied state Medicaid/ Medicare regulations. + Working knowledge of national, state, and… more
- Molina Healthcare (Atlanta, GA)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Evolent (Atlanta, GA)
- …we're redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal ... a focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates… more
- Morehouse School Of Medicine (Atlanta, GA)
- Clinical Trials Operations (CTO) Director - Clinical & Operational Implementation Bookmark this Posting Print Preview | Apply for this Job Please see Special ... ) is a place of distinction, serving as the nation's leading academic medical center for vulnerable populations. It's also a place for passionate individuals looking… more
- CenterWell (Atlanta, GA)
- …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more
- Bausch + Lomb (Atlanta, GA)
- …**Overview** Through depth and breadth of customer and industry knowledge, the ** Director , National Accounts** will be responsible for aiding in the development of ... these programs it is also the expectation that the National Account Director will take responsibility for communication, facilitation and implementation with these… more