• National Utilization…

    Humana (Atlanta, GA)
    **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
    Humana (06/06/25)
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  • Director of Utilization…

    Prime Healthcare (Riverdale, GA)
    …Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Director of Utilization ... on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military... utilization review and clinical appeals process. The Director of Utilization Management will… more
    Prime Healthcare (06/05/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Atlanta, GA)
    …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
    Zurich NA (05/22/25)
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  • Divisional Director of Care…

    CenterWell (Atlanta, GA)
    …for managing populations and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with travel requirements ... solutions that will lead to acute and post-acute care utilization reductions aligned with the PCO's objectives and goals....impact** **Required Qualifications:** + **At least 5 years of Management experience required** ; _3-5 years of Director… more
    CenterWell (05/23/25)
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  • Medical Director - Medicaid N. Central

    Humana (Atlanta, GA)
    …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (05/14/25)
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  • Social Services Director of Care…

    Emory Healthcare/Emory University (Atlanta, GA)
    …all case management activities at the local hospital, including utilization management , transitions of care, discharge planning, payer authorization, medical ... and leadership programs + And more **Description** We are seeking a capable ** Director , Care Management ** who has acquired broad experience in caring for… more
    Emory Healthcare/Emory University (05/08/25)
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  • Medical Director , MSK Surgery

    Evolent (Atlanta, GA)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Medical Director - Care Plus - Florida

    Humana (Atlanta, GA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (04/24/25)
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  • Field Medical Director , Interventional…

    Evolent (Atlanta, GA)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (04/30/25)
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  • Medical Director - Florida

    Humana (Atlanta, GA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (06/05/25)
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