- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Raleigh, NC)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Raleigh, NC)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- Evolent Health (Raleigh, NC)
- …including the CEO, CFO, CMO, pharmacy leadership, clinical operations/UM, medical economics/actuarial services/analytics, and vendor management . **Performance ... Management ** - maintain overall accountability for medical expense and P&L performance of designated client partners, including the facilitation of… more
- J&J Family of Companies (Raleigh, NC)
- …safety data, international regulatory safety databases, and other data sources, eg, claims and electronic medical records. This position develops and implements ... Associate Director , Signal Detection Scientist - 2406212640W **Description** Johnson...position is to lead the implementation of the Signal Management Group's aggregate surveillance strategies for proactive and systematic… more
- Cardinal Health (Raleigh, NC)
- …future. The Director , Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible to ... implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing contracting… more
- Sumitomo Pharma (Raleigh, NC)
- …a dynamic, highly motivated, and experienced individual for the position of ** Director , Market Access Insights** to support US Market Access strategic and tactical ... navigating complex organizational structures / experience in highly matrixed environments. The Director will be a member of the Commercial Insights team. This… more
- Takeda Pharmaceuticals (Raleigh, NC)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... guidance. **How you will contribute:** With guidance from leadership: Management of Labeling Cross-Functional Teams + Independently leads Labeling cross-functional… more
- The Cigna Group (Raleigh, NC)
- **Summary** The Business Analytics Director will be responsible for strategizing and leading operational analytics, reporting and program implementation initiatives ... analytics, reporting implementation & innovation, market support analytics and financial management reporting etc. + Interact daily with the Affordability, Product,… more
- Evolent Health (Raleigh, NC)
- …core Payer Data Warehouse datasets and Evolent Data Warehouse tables, including medical , pharmacy and ancillary claims data, membership data, clinical ... a growth mindset as we solve complex business problems. **Collaboration Opportunities** The Director , Client Analyst role will be serving as a strategic advisor to… more
- Evolent Health (Raleigh, NC)
- …models using healthcare data (ie, both structured and unstructured data from operations, claims , and medical charts) to solve complex problems, drive innovation, ... in everything from scrubs to jeans. **Position summary** As an Associate Director , Data Scientist (Machine Learning Engineer), you will be responsible for… more
- IQVIA (Durham, NC)
- …complex incentive programs, delivering end-to-end speaker bureau strategy and management , or optimizing every HCP interaction, IQVIA Technologies enable healthcare ... insights from advanced analytics and artificial intelligence in the management , coordination, and optimization of resources in support of...& Rules based Analytics + HCP Behavioral Data + Claims Data + Patient Lab Data + Next Best… more
- HUB International (Raleigh, NC)
- … Management Systems Trainer (Epic/Benefit Point) works with the COO/ Director of Training, Operations Managers, Regional and Local Operations Leaders, Regional ... employee benefits broker, providing a broad array of property, casualty, risk management , life and health, employee benefits, investment and wealth management … more
- HomeSafe Alliance (Raleigh, NC)
- **Title:** Operations Supervisor - Move Management (International Alaska) **_HomeSafe Alliance_** is the single global household goods movement manager of over ... directly or through PPM options + Provide consolidated oversight and management of coordinators under supervision + Monitor international operations performing… more
- Stantec (Raleigh, NC)
- …and forecasting. + Experience with scheduling large, complex projects. + Experience with claims management for design projects. + Sound knowledge and experience ... Claims /Risk mitigation. + Oversee and approve development and management of the Project Scope WBS. + Oversee and...Internal (PGC) Monthly Reports; issue following review with Design Director . + Responsible for the formulation of the Project… more
- Prime Therapeutics (Raleigh, NC)
- …+ Experience writing SQL queries + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... as assigned **Minimum Qualifications** + Bachelor's Degree in Business Administration, Management , Economics or related area of study, or equivalent combination of… more
- Evolent Health (Raleigh, NC)
- …leaders across the organization, training and development, provider relations, member services, claims management and our implementation team will also be ... plans and serves in a supporting role to the Director , Intake and Utilization Management Operations. +...population management or managed care/insurance or hospital medical management department setting may be substituted… more
- Conservation Legacy (Durham, NC)
- …experience . Familiarity with Office 365, SharePoint, Salesforce, or other relevant database management . Relevant medical certification (WFR, WFA, WEMT, or OEC) ... Personnel Policies, and other opportunities as available Reports to: Program Director Posting Period: Priority application date: September 23rd, 2024. Position will… more
- UNC Health Care (Chapel Hill, NC)
- …well-being of the unique communities we serve. **Job Summary:** Reporting to the Director of Clinical Risk Management , the Clinical Risk Manager is responsible ... for administering the risk management program and ensuring effective loss prevention/control and compliance...approaches intended to reduce the frequency and severity of medical malpractice and patient injury claims . 3.… more
- Granville Health System (Oxford, NC)
- …of claims .# Responsible for abstracting diagnoses and procedures from medical record into the Hospital Health Information system for timely billing.# Performs ... Compliance program. Responsible to detect, observe and report compliance variances to the Director of Health Information Management or upward through the chain… more