- Elevance Health (Durham, NC)
- The Children and Families Specialty Health Plan is looking to hire a Director of Care Management to lead the care management team in Medicaid ... of our Durham office. (The internal company title is Director of Special Programs and Services) How you will...Carolina Medicaid Regions of the statewide CFSP Care Management model. This responsibility includes required… more
- CVS Health (Raleigh, NC)
- …educational material to support market intelligence. + Engage with market clinical team, care management team, member services team; attend market level meetings ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...Adjustment Programs for a portfolio of Aetna Better Health Medicaid Plans. Reporting to the Lead Director … 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)
- …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
- Abt Global Inc. (Durham, NC)
- …work? Now's your chance. **The Opportunity** Abt Global seeks to expand its health care research team with the addition of a health care research expert ... directing projects funded by the Centers for Medicare and Medicaid Services (CMS). As a member of the Research,...join Abt's team of experts to conduct policy-relevant health care research and evaluation focused on post-acute care… 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)
- …skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess ... 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 … more
- UNC Health Care (Holly Springs, NC)
- …to join their leadership team to oversee Nursing Operations, along with Surgery, Pharmacy, Care Management , and Rehab Therapy. The ideal candidate will bring a ... for Holly Springs Hospital. Oversees clinical divisions to include care management , respiratory, medical/surgical, surgical services, emergency department,… more
- CVS Health (Raleigh, NC)
- … will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and ... in Health Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM (Utilization Management ) experience *Active and current state… 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)
- …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
- 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
- Granville Medical Center (Oxford, NC)
- …regulations, institutional policies and procedures and Standards of Nursing Practice for patient care . Director must be a positive role model by demonstrating ... and evaluating all nursing, administrative and related technical activities to ensure care of all patients in Obstetrical Services. Responsible for ensuring all… more
- Granville Health System (Oxford, NC)
- …regulations, institutional policies and procedures and Standards of Nursing Practice for patient care . Director must be a positive role model by demonstrating ... and evaluating all nursing, administrative and related technical activities to ensure care of all patients in Obstetrical Services. #Responsible for ensuring all… more
- United Therapeutics (Raleigh, NC)
- …orphan diseases. **How you'll contribute** The Associate Analytics, Insights and Operations Director , Market Access will lead data support across all functions of ... to support decisions regarding policy and reimbursement landscape + Support senior management in all financial, sales, and new business modeling + Provide data… more
- Prime Therapeutics (Raleigh, NC)
- …Operations **Job Description Summary** This position provides administrative oversight and management of rebate operations team and is responsible for directing day ... department. Solution issues and communicate issues and recommended solutions to upper management . Enforces teamwork across all internal departments, as well as with … more
- Mathematica (Raleigh, NC)
- …of data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... HIEs, to effectively answer research questions about health care policy. * Incorporate client and other stakeholder needs into solution design, communication… more
- Public Consulting Group (Raleigh, NC)
- …the important points of intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Evolent (Raleigh, NC)
- …value-based care programs for oncology, cardiology, and musculoskeletal disease Leadership/ management + Leads performance management of clinical teams to ... objectives **Desired Skill Set** + Understanding of regulatory framework for utilization management in Medicare, Medicaid , and Commercial contexts + 5+ years… more
- Prime Therapeutics (Raleigh, NC)
- … organization, or within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible ... Prime's employee and leadership expectations. + Serves as a consultant to management on major matters pertaining to laws and regulations, policies, plans and… more