- Elevance Health (Raleigh, NC)
- …Health office locations Work schedule: Monday - Friday, standard business hours.** The Medical Director Clinical Programs is responsible for designing and ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...implementing clinical programs with specific medical condition focus for all lines of business enterprise… 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 works on problems of diverse...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… 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...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 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)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... consumer experiences and a highly engaged team culture The Medical Director conducts clinical case... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- CenterWell (Raleigh, NC)
- …in Medicare /seniors * Demonstrated ability to work collaboratively with clinical and operational leaders across a complex health care organization. * Knowledge ... a part of our caring community and help us put health first** **National** ** Director of Transitional Care and High-Risk Patient Management** The Director of… more
- Humana (Raleigh, NC)
- …put health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (Maternal-Child Health) who will lead teams of nurses and ... responsible for maternal and child services care management. The Associate Director , Care Management (Maternal-Child Health) works within specific guidelines and… more
- Humana (Raleigh, NC)
- …+ Leads positive performance of medication adherence, statin use, polypharmacy, and Medicare Plan Finder measures for Pharmacy by influencing both the strategy and ... + Five years of leadership experience + Eight years clinical experience in managed care or equivalent experience +...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Associate Director of Contractor Workforce Management will drive a best-in-class contractor workforce ... and Direct Sourcing Platforms + MSP management experience + Technical and Clinical Contingent Labor management experience + Excellent analytical skills; ability to… 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 (Raleigh, NC)
- …: Raleigh, NC **This is not a remote or work-from-home position.** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the… more
- UNC Health Care (Chapel Hill, NC)
- …and organizational / regulatory agency surveys. Communicates effectively with physicians, medical director , other providers, and co-workers. Provides patient ... practice and critical thinking. Conducts exercise testing where applicable. Recognizes potential medical problems in all clinical situations and works in… 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 ... Clinical Reviewers as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure consistency in the MD… more
- Humana (Raleigh, NC)
- …assigned health plan and/or specialty companies relative to Medicare /Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and ... collaborative organization which includes Provider Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment. Reporting… more
- Highmark Health (Raleigh, NC)
- …+ Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to drive ... as an adjunct to health coaching. If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case… more