- Evolent (Atlanta, GA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Liberty Utilities (Gainesville, GA)
- Director , Vendor Performance Management LU Service Corp. Downey, CA, US, 90241Litchfield Park, AZ, US, 85340Joplin, MO, US, 64801Londonderry, NH, US, ... rewarding both the goal outcome and how we achieve it.** **Purpose** The Director , Vendor Performance Management is accountable for the governance, performance,… more
- Humana (Atlanta, GA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Atlanta, GA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Molina Healthcare (GA)
- …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management ...all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the… more
- Molina Healthcare (Atlanta, GA)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Evolent (Atlanta, GA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Savannah, GA)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs… more
- Humana (Atlanta, GA)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... community and help us put health first** The Medical Director relies on broad clinical expertise to review...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Elevance Health (Atlanta, GA)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management...any case review decisions that require Medical Director review or policy interpretation. **Minimum Requirements:**… more