• Medical Director - National…

    Humana (Atlanta, GA)
    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
    Humana (10/25/25)
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  • Medical Director (AZ)

    Molina Healthcare (Atlanta, GA)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/17/25)
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  • Medical Director -PSCCR

    Elevance Health (Atlanta, GA)
    ** Medical Director -PSCCR** Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... an accommodation is granted as required by law. The ** Medical Director -PSCCR** is responsible for the administration...player, collaborative, and capable of independent work. + Prior UM review experience. For candidates working in person or… more
    Elevance Health (11/05/25)
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  • Medical Director (NV)

    Molina Healthcare (Atlanta, GA)
    JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
    Molina Healthcare (10/31/25)
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  • Clinical Reviewer, Nurse ( Medical…

    Evolent (Atlanta, GA)
    …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
    Evolent (10/21/25)
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