- Elevance Health (Raleigh, 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
- 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)
- …Information** + The Medical Director conducts clinical reviews of the care received by members in assigned LTSS Medicaid states, member population, ... materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State Medicaid ...based care , population health, or disease or care management . **Use your skills to make… 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
- Humana (Raleigh, NC)
- …people management experience + Advanced experience working in compliance, risk management , or managed- care field. Providing oversight and auditing managed ... our caring community and help us put health first** The Associate Director , Compliance ensures compliance with governmental requirements. The Associate Director ,… 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
- 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 ... Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested… 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
- Humana (Raleigh, NC)
- …we are at the forefront of delivering cutting-edge AI technologies for improving care quality and experience of millions of consumers. We are actively seeking top ... to best practices in accountable AI for effective risk management and measurement. Join us in shaping the future...shaping the future of healthcare through AI excellence. The Director of Data Science is responsible for spearheading the… 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
- UNC Health Care (Smithfield, NC)
- …the Clinical Exercise Physiologist is directly involved in patient care , patient education, program development, and quality performance improvement. ... pressures, blood glucoses, and O2 Sats. Attends and participates in patient care conferences. 2. Develops exercise prescriptions according to age, disease, medical… 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
- 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 ... and submitting applications for licensure **Preferred Qualifications** + PBM/health care experience + Commercial/Medicare Part D/ Medicaid /ACA experience +… 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
- Sunrise Senior Living (Raleigh, NC)
- …best place that I've ever worked, simply because of the people. We provide quality care in an environment that feels like home. Our focus is doing what's right for ... transactions entered are authorized and processed accurately; works collaboratively with the care departments to ensure resident care and billing information is… more