• Medical Director - Pharmacy Appeals

    Humana (Atlanta, GA)
    …a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). ... The Medical director work assignments involve moderately complex to complex issues...National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate.… more
    Humana (08/22/25)
    - Related Jobs

  • Medical Director

    Molina Healthcare (GA)
    …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective ... resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient… more
    Molina Healthcare (08/20/25)
    - Related Jobs

  • Sr Dir Pharmacy Trade Relations - Remote

    Prime Therapeutics (Atlanta, GA)
    …our passion and drives every decision we make. **Job Posting Title** Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr Director , Pharmaceutical ... for managing Prime's Trade Relations program(s) for medical and pharmacy formulary and market access strategies and all related...on Medicare Part D and Managed Medicaid. The Sr Director , Pharm Trade Relations leads a team of directors… more
    Prime Therapeutics (08/08/25)
    - Related Jobs

  • 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 ... for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs… more
    Centene Corporation (08/23/25)
    - Related Jobs

  • Director , Physician Leadership - Medical…

    Humana (Atlanta, GA)
    …The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team ... are seeking an accomplished healthcare physician leader for the newly-created role of Director , Physician Leadership. In this role, you will be a key enterprise… more
    Humana (08/21/25)
    - Related Jobs

  • Sr Director Clinical Strategy and Oncology…

    Prime Therapeutics (Atlanta, GA)
    …and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job Description** ... The Senior Director Clinical Strategy and Oncology Specialty Solutions is responsible...of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership and direction… more
    Prime Therapeutics (07/01/25)
    - Related Jobs

  • Clinical Solutions Strategy Senior Director…

    Prime Therapeutics (Atlanta, GA)
    …every decision we make. **Job Posting Title** Clinical Solutions Strategy Senior Director - Remote **Job Description** The Clinical Solutions Strategy Senior ... Director is responsible for developing new, bold clinical solutions...and implementation of innovative drug solutions, including optimizing drug utilization , patient outcomes, and cost-effectiveness through value-based care models,… more
    Prime Therapeutics (07/31/25)
    - Related Jobs

  • Sr VP Medical Director (Hourly)

    Sedgwick (Atlanta, GA)
    …Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20 hours per week. **PRIMARY ... required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality...+ Knowledge about general claim practices. + Knowledge of pharmacy processes and pharmacy benefit management a… more
    Sedgwick (08/22/25)
    - Related Jobs

  • Sr. Director Actuarial Forecasting - REMOTE

    Prime Therapeutics (Atlanta, GA)
    …fuels our passion and drives every decision we make. **Job Posting Title** Sr. Director Actuarial Forecasting - REMOTE **Job Description** The Senior Director of ... functional leadership to develop and maintain projected trend assumptions related to utilization , unit cost, and gross/net rebate assumptions + Owns the annual… more
    Prime Therapeutics (07/12/25)
    - Related Jobs

  • Atlanta Market - Medical Director

    ChenMed (Atlanta, GA)
    …expanding and we need great people to join our team. The Regional Medical Director (RMD) is a developmental, pathway role to Market Chief Medical Officer which is ... care expert teams with ancillary medical services, including dental, vision, pharmacy and acupuncture. By maximizing doctors and services in "one shop",… more
    ChenMed (06/03/25)
    - Related Jobs