• Director of Care Management

    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 ... more
    Elevance Health (01/17/25)
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  • Manager, Medicaid Risk Adjustment

    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 ... more
    CVS Health (01/04/25)
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  • Medical Director --Claims Management

    Humana (Raleigh, NC)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... more
    Humana (01/28/25)
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  • Physician Medical Director - LTSS

    Humana (Raleigh, NC)
    …Information** + The Medical Director conducts clinical reviews of the care received by members in assigned LTSS Medicaid states, member population, ... more
    Humana (01/25/25)
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  • Medical Director - Gulf South

    Humana (Raleigh, NC)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... more
    Humana (12/03/24)
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  • Medical Director - Mid West Region

    Humana (Raleigh, NC)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... more
    Humana (01/30/25)
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  • Associate Director , Compliance

    Humana (Raleigh, NC)
    …people management experience + Advanced experience working in compliance, risk management , or managed- care field. Providing oversight and auditing managed ... more
    Humana (01/30/25)
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  • Medicare Grievances and Appeals Corporate Medical…

    Humana (Raleigh, NC)
    …skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess ... more
    Humana (01/07/25)
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  • Director Clinical Operations - UNC Rex…

    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 ... more
    UNC Health Care (12/28/24)
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  • Field Medical Director , Interventional…

    Evolent (Raleigh, NC)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... more
    Evolent (01/30/25)
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  • Medical Director - Commercial Appeals

    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 ... more
    CVS Health (11/13/24)
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  • Field Medical Director , Cardiology

    Evolent (Raleigh, NC)
    Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested ... more
    Evolent (11/15/24)
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  • Associate Director Cloud Architecture

    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 ... more
    Humana (11/02/24)
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  • Field Medical Director , Radiology (General…

    Evolent (Raleigh, NC)
    Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in ... more
    Evolent (12/09/24)
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  • Director , Women's Services

    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 ... more
    Granville Medical Center (01/09/25)
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  • Director , Women's Services

    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 ... more
    Granville Health System (01/08/25)
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  • Manager Rebate Pharmacy Operations

    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 ... more
    Prime Therapeutics (11/06/24)
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  • Manager Charge Master- HIM Revenue Integrity

    UNC Health Care (Chapel Hill, NC)
    …Manager will be responsible for ensuring the integrity of the UNC Health Care System Charge Description Master (CDM) and related processes. This position will lead ... more
    UNC Health Care (01/28/25)
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  • Principal Client Solution Architect - State…

    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 ... more
    Mathematica (01/04/25)
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  • Senior Compliance Analyst (Regulatory Complaints…

    Prime Therapeutics (Raleigh, NC)
    …or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible ... more
    Prime Therapeutics (01/29/25)
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