- Humana (Raleigh, NC)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the KY, OH… more
- Humana (Raleigh, NC)
- …work, communication of decisions to internal associates, and possible participation in care management , with clinical scenarios arising from outpatient or ... help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy...value-based care , population health, or disease or care management + Supports Humana values including… more
- Humana (Raleigh, NC)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national...of business. The Medical Director conducts Utilization Management of the care received by members… more
- Humana (Raleigh, NC)
- …Information** + The Medical Director conducts clinical reviews of the care received by members in assigned LTSS Medicaid states, member population, ... materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State Medicaid ...based care , population health, or disease or care management . **Use your skills to make… more
- Humana (Raleigh, NC)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... management . + Prefer Medical Hematology/Oncology specialties + Prefer Medicaid experience + Utilization management experience in...Director . The Medical Director conducts Utilization Management of the care received by members… more
- Prime Therapeutics (Raleigh, NC)
- …fuels our passion and drives every decision we make. **Job Posting Title** Senior Director Clinical Account Management - Remote **Job Description** The Sr ... Director of Clinical Account Management is responsible for providing strategic and operational leadership...relevant client services experience in healthcare or pharmacy benefit management , preferably in Medicaid . + 5 years… more
- Humana (Raleigh, NC)
- …provider centric assets, Medicaid , Medicare, Homecare, and IT services. The Director of Investment Portfolio Management in Corporate Development role is to ... value creation from our investments and ensure accountability to Management and the Board. Key Responsibilities + Develops and...serve to achieve their best health - delivering the care and service they need, when they need it.… more
- CVS Health (Raleigh, NC)
- …during the plan year. The **Medicare** **Benefits Standards & Guidance Lead Director ** ensures accountability for the implementation, management , and maintenance ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- AmeriHealth Caritas (Raleigh, NC)
- …care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral ... participation in the annual budget process and reconciliation of operational staff.; The director is a critical member of management who provides membership,… more
- Evolent (Raleigh, NC)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested… more
- Evolent (Raleigh, NC)
- … Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested ... **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the...exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and… more
- Humana (Raleigh, NC)
- …community and help us put health first** The Risk Adjustment Compliance Director ensures compliance with governmental requirements. The Risk Adjustment Compliance ... Director requires an in-depth understanding of how organization capabilities...methodologies and tools for effective compliance oversight and risk management across the risk adjustment organization. This should include… more
- Evolent (Raleigh, NC)
- …idea and value creation. + Provide **clinical** **expertise** **in** **utilization** ** management (UM),** ensuring high-value care aligned with national ... management , and senior leadership,** to improve decision-making and care outcomes. + Assist in **research, policy interpretation, and guideline development**… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic and ... the development of long-term growth plans and profitability goals The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic… more
- Humana (Raleigh, NC)
- …and be their most productive. Against that backdrop, we are seeking a Director of Financial Operations of Home Health Solutions who will provide program ... leadership can evaluate alternatives against the organization's business objectives. The Director of Financial Operations requires a strong understanding the Home… more
- Evolent (Raleigh, NC)
- … Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in ... culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the...exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and… more
- Humana (Raleigh, NC)
- …we are at the forefront of delivering cutting-edge AI technologies for improving care quality and experience of millions of consumers. We are actively seeking top ... to best practices in accountable AI for effective risk management and measurement. Join us in shaping the future...shaping the future of healthcare through AI excellence. The Director of Data Science is responsible for spearheading the… more
- Humana (Raleigh, NC)
- …improving health outcomes for each member we serve. Our focus on quality care , member satisfaction and innovation are key to our success. **Location:** remote ... Health Quality and Stars (HQS) leadership team as the Director , Competitive Intelligence to drive the strategic vision of...the strategic vision of the company's Stars competitive knowledge management system. This is an exciting new position that… more
- CenterWell (Raleigh, NC)
- …procedures are followed, and fosters collaboration across entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and ... (including Annual Proof of Documentation (APD) tool) + Responsible for performance management and strategy development for PCO risk adjustment at the division and… more
- Gentiva (Raleigh, NC)
- …Dental, Vision Plans + Wellness Program and Resources including: + A dedicated Accolade Care Coordinator for personalized care management support of all your ... you will:** + Work in collaboration with the Palliative Care Medical Director and other palliative team...patient may be appropriate for home health or hospice care ; Medicare/ Medicaid regulations; and interdisciplinary process. +… more