• Director , Appeals & Grievances (Medicare…

    Molina Healthcare (Macon, GA)
    …Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management, and other business partners to… more
    Molina Healthcare (07/18/25)
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  • Clinical Documentation and Claims Integrity…

    Elevance Health (Atlanta, GA)
    **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model ( remote ... home-care and community based services. The **Clinical Document Improvement Director ** is responsible for leading encounter processing, diagnostic documentation and… more
    Elevance Health (07/18/25)
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  • Director , Operational Oversight…

    Molina Healthcare (Savannah, GA)
    …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners… more
    Molina Healthcare (07/13/25)
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  • Remote Medical Director - Georgia

    Centene Corporation (Atlanta, GA)
    …perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
    Centene Corporation (07/26/25)
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  • Director , Health Plan Analytics…

    Two95 International Inc. (Atlanta, GA)
    Job Title: Director , Health Plan Analytics Job type : Remote Work Type : 6+ Months Contract with extension Rate : $Market /Hour Requirements Position Summary: As ... the Director of Analytics, you will lead a team of...including but not limited to enrollment, finance, call center, claims , Case Management and Utilization Management * 5+ years… more
    Two95 International Inc. (06/09/25)
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  • Director , Enrollment (Duals)…

    Molina Healthcare (GA)
    …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
    Molina Healthcare (07/31/25)
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  • Director , Operational Oversight - Medicare…

    Molina Healthcare (Augusta, GA)
    …5 years of experience in Medicare, DSNP and CSNP population, Enrollment, A&G, Claims , Compliance, or other Operations experience To all current Molina employees: If ... you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 -… more
    Molina Healthcare (07/19/25)
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  • Director , Applications (AI/Azure…

    Molina Healthcare (Atlanta, GA)
    …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
    Molina Healthcare (06/29/25)
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  • Senior Director , Finance - Emory Health…

    Emory Healthcare/Emory University (Atlanta, GA)
    …to the diversity and excellence of our academic community. **Description** The Senior Director of Finance will serve as the financial leader of the Emory Health ... + The role is both strategic and hands-on, integrating financial planning, claims analysis, forecasting, risk management, and cost optimization. + The Senior … more
    Emory Healthcare/Emory University (07/15/25)
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  • Medical Director - Florida

    Humana (Atlanta, GA)
    …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
    Humana (07/29/25)
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