- 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)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… 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
- Sedgwick (Raleigh, NC)
- …rounding ability + Strong understanding of workers compensation, liability and disability claims management + In-depth knowledge of client servicing + Ability ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Client Services Director - Casualty | CST & EST Time Zones...EST Time Zones **PRIMARY PURPOSE** : To determine account management strategies related to client service plans; to be… 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
- Sedgwick (Raleigh, NC)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Director Marketing Campaign Strategy and Execution **PRIMARY PURPOSE OF THE ROLE:** ... The Director , Marketing Campaign Strategy and Execution is responsible for...improve client satisfaction. **QUALIFICATIONS** + 8+ years B2B Campaign Management leadership experience. + Solid experience with campaign technologies… more
- IQVIA (Durham, NC)
- …and support of IQVIA (TM) information assets - national, sub-national. patient claims data, channel & specialty offerings across multiple internal and external ... business issues, and creates a compelling support plan, including governance, change management , client education to meet the clients' needs. + Builds client… more
- CVS Health (Raleigh, NC)
- …health care more personal, convenient and affordable. **Position Summary:** **The Lead Director , Operations (hiring for two positions)** plays a key role by leading ... executive, providers, and administrative staff. + Relationship building + Medical cost, risk, and quality analysis + Transforming data...in a care delivery setting, population health and care management + 5+ years of strong Medicare and clinical… 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
- Robert Half Office Team (Durham, NC)
- …determinations that require a clinical review to a nurse or Medical Director . * Utilize various systems including RX Claims MHR Care Radius FACETS ... reviews. * Maintain accurate customer credit records, ensuring accuracy to avoid impacting claims payment. * Support the care management department by making… 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
- Motion Recruitment Partners (Durham, NC)
- …refers organization determinations that require a clinical review to a nurse or Medical Director . * Conducts reviews of authorizations entered to ensure accuracy ... to avoid impacting claims payment. * Supports the care management ...background check** **You will receive the following benefits:** + Medical Insurance - Four medical plans to… more
- Evolent Health (Raleigh, NC)
- …Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing ... medical treatment requests in accordance with departmental policies, regulatory...contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake Utilization … 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)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... with business partners across client facing divisions, product/ project management , analytics, operations, and IT to enable data-driven strategic decisions.… more
- Prime Therapeutics (Raleigh, NC)
- …and program impact measurement using eligibility, medical , and pharmacy administrative claims and external data, (eg, care management , disease management ... advanced scientific model design, including advanced predictive modeling, with health claims data, applying statistical theories and methods to solve complex… more
- Crowder Constructors Inc (Apex, NC)
- …Division Safety & Health Director + Daily support/interaction with Project Management & Superintendent(s) + Assist Claims Manager regarding all Workers' ... Health Coordinator: Assist Corporate and Division Safety & Health Director in maintaining the Company's Safety Program in a...access to the following benefits: + Health Plans, including Medical , Dental and Vision + Healthcare Savings and Flexible… 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
- Granville Health System (Oxford, NC)
- …when staffing issues require it. Minimum Qualifications: Two year associates degree in medical management preferred. Two years experience in medical office ... conjunction with GHS policy and procedure. Experienced in all aspects of Medical Office Administration. Allscripts practice management system preferred. EHR… more