- Molina Healthcare (Atlanta, GA)
- …relative to Molina Medicare . The Director is co-chairman of the Molina Medicare Compliance Committee. The Director , working with the MHI VP ... Compliance , is accountable to the Molina Medicare Compliance Committee for all ...implementation and maintenance of the Molina Medicare Compliance Plan and audit activities. The Director … more
- Humana (Atlanta, GA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- CVS Health (Atlanta, GA)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Humana (Atlanta, GA)
- …our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. ... The Corporate Medical Director works on problems of diverse scope and complexity...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Atlanta, GA)
- …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 scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Molina Healthcare (Atlanta, GA)
- …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module...entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the… more
- Molina Healthcare (Atlanta, GA)
- …of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Molina Healthcare (Atlanta, GA)
- …of Coverage for print and online distribution via the iCat authoring process, ensuring compliance with CMS guidelines. Support Medicare and MMP line of business ... completion including adhoc projects and submissions as assigned by the Director of Medicare Programs. **KNOWLEDGE/SKILLS/ABILITIES** + Initiate projects by… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… 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 ... + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Atlanta, GA)
- …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 ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Evolent (Atlanta, GA)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology to ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Aveanna Healthcare (Norcross, GA)
- …and agency regulations. This role includes comprehensive program oversight, policy development, compliance management, and staff leadership. The Director is also ... Intellectual and Developmental Disabilities Program Director ApplyRefer a FriendBack Job Details Requisition #: 205264 Location: Norcross, GA 30092 Category:… 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 key member of the utilization management team. We ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… 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 ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Aveanna Healthcare (Norcross, GA)
- Location Director ApplyRefer a FriendBack Job Details Requisition #: 205321 Location: Norcross, GA 30092 Category: Management Salary: $70,000.00 - $80,000.00 per ... year Position Details Executive Director Position Overview Step into an exciting leadership role...to your team, you'll ensure excellence in patient care, compliance with all regulations, and the adoption of best… more
- Aveanna Healthcare (Smyrna, GA)
- Executive Director RN PT or OT Home Health ApplyRefer a FriendBack Job Details Requisition #: 206053 Location: Smyrna, GA 30080 Category: Nursing Salary: $110,000.00 ... experience **Must be a RN, PT, or OT The Home Health Executive Director directly responsible for the administrative and leadership functions associated with all… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- Director , Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director , Field ... Drive post-prescribing performance through strategic planning and execution + Ensure compliance adherence through in-field visits, call and case monitoring, aligning… more
- Gentiva (Atlanta, GA)
- **Overview** We're looking for a ** Director of Palliative Care - RN** to join our team. You will report directly to the VP of Palliative Care. You will be ... Establish and maintain standards of high quality care and customer service in compliance with federal and state regulations and guidelines + May provide skilled… more