- Molina Healthcare (Macon, GA)
- …experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization… more
- Kyndryl (Atlanta, GA)
- …ultimately supporting execution. Partners will be focused on financial impact, utilization and contribution, client impact and leadership. **Contribute to Profitable ... as a strategic partner. + Bring consulting experience-preferably in the Healthcare space-to tailor engagements that resonate with industry-specific needs and… more
- Kyndryl (Atlanta, GA)
- …in contact center environments. + Excellent communication, presentation, and stakeholder management skills with C-Level. + Healthcare industry experience is ... leading healthcare -focused journey redesign from eligibility verification to care management . + Align contact center transformation with healthcare business… more
- Humana (Atlanta, GA)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in… more
- Humana (Atlanta, GA)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Atlanta, GA)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical ... behavioral health topics to the clinical operations team and healthcare organization. The Medical Director 's work includes...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Elevance Health (Atlanta, GA)
- **Medical Director -Pain Management /Anesthesia Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of required ... accommodation is granted as required by law. The **Medical Director Pain Management /Anesthesia Appeals** is responsible for...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Humana (Atlanta, GA)
- … management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers. + Utilization management experience in a ... size of region or line of business. The Medical Director conducts Utilization Management of...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Zelis (Atlanta, GA)
- …to enhance customer satisfaction, improve efficiency & quality assurance, performance management and achieving business objectives. The successful Director is ... it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare...Position Overview Zelis is seeking a dynamic and experienced Director of Operations to lead our Price Optimization Call… more
- Evolent (Atlanta, GA)
- …economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of healthcare underwriting methodologies + ... for the culture. **Who You'll Be Working With:** The Director , Performance Suite Analytics, utilizes and develops analytic tools...Familiarity with value-based care and utilization management + Understanding of data systems… more