- 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. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- CVS Health (Raleigh, NC)
- …and affordable. **Position Summary** As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to end profit & loss statements, ... data submission for the purpose of rate setting and medical trend analysis on behalf of the Health Plan....nature of this remote role, candidates must have some Medicare and/or Medicaid experience. **Required Qualifications** -5 or more… 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 ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of 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...materials, internal teaching conferences, and other sources of expertise. 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
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- CVS Health (Raleigh, NC)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
- Takeda Pharmaceuticals (Raleigh, NC)
- …to the best of my knowledge. **Job Description** **Regional Account Director ** **Takeda Pharmaceutical** **USA-MA-Virtual** **About the role:** Are you looking for ... you to shine? Join us as the Regional Account Director ; reporting into the Head of Corporate Accounts. This...accounts. Responsible for all books of business - Commercial, Medicare , State Medicaid and Managed Medicaid + Gain, protect… more
- Granville Medical Center (Oxford, NC)
- …with standards established by The Joint Commission, Centers for Medicare & Medicaid Services (CMS), hospital bylaws, departmental regulations, institutional ... policies and procedures and Standards of Nursing Practice for patient care. Director must be a positive role model by demonstrating professional practice and… more
- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Humana (Raleigh, NC)
- …in the country. **Location:** remote The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business. This business unit, Humana's largest, ... strategy for the business unit, evolving key dimensions of the Medicare Advantage growth strategy, developing a refreshed membership acquisition strategy, assessing… more
- Humana (Raleigh, NC)
- …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises ... experience leveraging core consulting skills to support delivering some of Medicare and Medicaid's highest priority projects and initiatives, with an emphasis… more
- CenterWell (Durham, NC)
- …a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, ... strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing...accordance with standards of care. + Follows level of medical care and quality for patients and monitors care… more
- CenterWell (Raleigh, NC)
- …Operations Lead** **Job Summary** The Program Delivery Lead will partner with the National Director of Program Delivery to design, communicate, and implement ... regarding implementation, planning, and execution of programs and advises the Director of Program Delivery and significant functional strategies. The Program… more
- Mathematica (Raleigh, NC)
- …and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through ... methodology. * Conceptual and practical knowledge of health data (eg commercial, Medicare , Medicaid, or APCD claims data; EHR and/or HIE data; healthcare… more
- Evolent (Raleigh, NC)
- … Officer. The CCO will lead the Clinical Operations team and work with medical director leadership to ensure consistent and efficient adjudication of clinical ... Services team, the CCO will also have dotted line oversight over field medical director (FMD) operational responsibilities, provide strategic input into … more
- Humana (Raleigh, NC)
- …Manager will work closely with the Customer Success AVP, Customer Success Director , and cross-functional teams to drive strategic priorities, and provide valuable ... healthcare model. **Strategic Collaboration and Leadership** + Partner with AVP, Director , and peer leaders to align team strategies with broader organizational… more
- UNC Health Care (Smithfield, NC)
- …and organizational / regulatory agency surveys. Communicates effectively with physicians, medical director , other providers, and co-workers. Provides patient ... exercise therapy that is integrated and compatible with the patient-focused medical goals. Primary responsibilities include the development and implementation of the… more