- Evolent Health (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Director , Utilization Management, you'll work with your managers, front line clinical team, and ... for our members, providers, and customers. **Collaboration Opportunities:** The Director , Utilization Management, will partner with a variety of different… more
- Elevance Health (Cary, NC)
- …within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral health medical ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you will… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management Nurse performs daily medical necessity reviews. This position reports to the Director , Clinical Programs. This job description is not designed to cover or ... turnaround times. + Prepares and presents cases to Medical Director (MD) for medical director oversight and...URAC and NCQA. + 2+ years' experience in a UM team within managed care setting. + 3+ years… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …meet required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. ... review. * Working knowledge of URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. * 3+ years' experience in clinical nurse setting… more
- Highmark Health (Raleigh, NC)
- …in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to… more