- Wellstar Health System (Marietta, GA)
- …appropriate referral to the Peer Review process if necessary. k) Assist in review of any reports from regulatory agencies, ie, RAC audits, QIO reports, etc. ... industry, and in people's lives. Job Summary: The Executive Director , MD Physician Advisor reports to and is accountable...Management: The PRN Physician Advisor (PA) will conduct clinical review cases sent for review for commercial… more
- State of Georgia (Atlanta, GA)
- …to legal inquiries. The General Counsel works with the agency head (Executive Director ) and agency divisions to review and enforce license, and contract ... administrative hearings. Extensive experience providing legal counsel to Director /Executive Director /Agency Head in the development and review of proposed… more
- PruittHealth (Norcross, GA)
- …Consultant is to support long-term care centers in achieving and sustaining regulatory compliance by conducting mock surveys, identifying areas of risk, and guiding ... 1. Conduct facility-wide mock surveys aligned with CMS and state regulatory standards, including clinical, environmental, and life safety areas. 2. Identify… more
- Sumitomo Pharma (Atlanta, GA)
- …seeking a dynamic, highly motivated, and experienced individual for the position of ** Director , Regulatory Advertising & Promotion** . The Director is ... (GRA) team based in the US. He/she will primarily function as the Regulatory reviewer for assigned products. This position is responsible for providing strategic,… more
- State of Georgia (Fulton County, GA)
- …to legal inquiries. The General Counsel works with the agency head (Executive Director ) and agency divisions to review and enforce license, and contract ... hearings. + Extensive experience providing legal counsel to Director /Executive Director /Agency Head in the development and review of proposed rules… 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 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 actively uses their medical background, experience, and judgement...be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources,… more
- Molina Healthcare (Atlanta, GA)
- …3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice . + Current clinical knowledge. + Experience ... a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides… 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
- 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, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by… 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 17-Jun-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
- Centene Corporation (Atlanta, GA)
- …perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement ... cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and… 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 , 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
- Molina Healthcare (Atlanta, GA)
- …a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff. **Job Duties** + ... medical cost savings and quality improvement opportunities. + Accounts for regulatory and accreditation performance of assigned team and responds to inquiries,… 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 ... 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
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …: Reporting to the Vice President, Global Medical Affairs, the Executive Director , CNS Strategy, Global Medical Affairs is a leadership position responsible for ... is accountable for the evidence generation and communication of practice relevant information about the products and disease to...and plans + Represents Global Medical Affairs on Copy Review governance committee + Is a core member of… more
