- 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 ... in accordance with Medicare and Humana policy. **Please note that this Medical Director position is non-benefitted, and compensated hourly * **Use your… more
- Molina Healthcare (Atlanta, GA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +...provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- Molina Healthcare (Atlanta, GA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Molina Healthcare (Atlanta, GA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +...provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- Merck (Atlanta, GA)
- …with HSO MADs + Serves as a resource for the PM MAD-HSO Team Lead, HSO Executive Director Medical Affairs, and other members of US Medical Affairs on other ... **Job Description** + The Precision Medicine - Medical Affairs Director - Health Systems...research \#eligibleforERP **Required Skills:** Benefit Programs, Clinical Data, Clinical Pharmacy , Clinical Studies, Medical Affairs, Medical… more
- Molina Healthcare (Atlanta, GA)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- CenterWell (Marietta, GA)
- …changes to Market President. Dyad Partnership: *Collaborate with the Associate Medical Director to achieve shared goals, ensuring consistent communication ... caring community and help us put health first** The Associate Operations Director (AOD) leads Senior Focused Primary Care clinical operations in a multi-physician… more
- CenterWell (Marietta, GA)
- …participant and lead with the care team through daily huddles. . Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of ... + Appropriate certification to write prescriptions under the authority of a collaborating physician/ medical director + This role is considered patient facing and… more
- CenterWell (Stone Mountain, GA)
- … medical expertise with the care team through daily huddles. . Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
- CenterWell (Roswell, GA)
- …treats center patients in accordance with standards of care. + Follows level of medical care and quality for patients and monitors care using available data and ... limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care. + Acts as...the care team through daily huddles. + Helps RegionalMedical Director and Center Administrator in setting a tone of… more
- CenterWell (Decatur, GA)
- … medical expertise with the care team through daily huddles. + Helps Area Medical Director and Center Administrator in setting a tone of cooperation in ... protocol defined by Clinical Leadership. + Meets with Area Medical Director and Lead Cardiologist about quality...pump + Work experience in electrophysiology + Experience managing Medicare Advantage panel of patients with understanding of Best… more
- CenterWell (Duluth, 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 ... final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more