- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director reviews cases of diverse scope...rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality standards. Represents Humana at… more
- CenterWell (Raleigh, NC)
- …part of our caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic pharmacy leader responsible for developing, ... Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: +...(SME) and clinical liaison to the national clinical leadership (including Chief Medical Officer, Complex… more
- UNC Health Care (Chapel Hill, NC)
- …and other staff to ensure appropriate medical staff involvement in clinical management efforts. Assists Director in ensuring the collection, analysis, ... of the unique communities we serve. **Summary:** Responsible for assisting the Director of Transplant Services in overall operations for Ventricular Assist Device,… more
- Prime Therapeutics (Raleigh, NC)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description ... Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all … more
- Humana (Raleigh, NC)
- **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Raleigh, NC)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Elevance Health (Raleigh, NC)
- …reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...an entire clinical program and/or independently performs clinical reviews. + The Medical Director… more
- CenterWell (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Director , Medical Coding extracts clinical information from a variety of ... and medical codes (eg, ICD-10-CM, CPT) to patient records. The Director , Medical Coding requires an in-depth understanding of how organization capabilities… more
- Humana (Raleigh, NC)
- …They will lead and guide others in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding ... health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare professionals… more
- United Therapeutics (Durham, NC)
- …successfully gained FDA approval for five medicines, we are always conducting new clinical trials, and we are working to create an unlimited supply of manufactured ... and pulmonary diseases, and other orphan diseases. **How you'll contribute** The Director , Commercial Strategy - Market Access develops, guides, and implements the… more
- Prime Therapeutics (Raleigh, NC)
- …and drives every decision we make. **Job Posting Title** Trade Client Strategy Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Cardinal Health (Raleigh, NC)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- BrightSpring Health Services (Raleigh, NC)
- …monitoring both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Providing clinical teaching and conducting performance ... with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case… more
- CenterWell (Durham, NC)
- …requires you to sit on-site at our Raleigh, NC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. This role is a focused on both...final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more
- Prime Therapeutics (Raleigh, NC)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more
- Option Care Health (Raleigh, NC)
- …nursing department. Coordinates all patient care and services in cooperation with the Director of Pharmacy. Facilitates a clinical networking system for the ... and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health...Regional Manager of nursing is responsible for assisting the Sr./ Director , Operations and/or Area Director of Nursing… more
- Humana (Raleigh, NC)
- …regulations. + Cultivate effective partnerships in a matrix environment of coding educators, medical director , clinical and market operations. + Facilitate, ... and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology. This role reports… more