- 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)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Elevance Health (Durham, NC)
- …the afternoons. Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical ... ** Medical Director - Medicare (Part-time)**...gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status… 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- RVO Health (Charlotte, NC)
- **AT A GLANCE** RVO Health is looking for an Associate Director , Medicare Product Manager to improve how seniors find and select their Medicare plans. 88% of ... seniors report that they find enrolling in a Medicare plan to be confusing and overwhelming. Our mission...different subjects at your fingertips + Health Insurance Coverage ( medical , dental, and vision) + Life Insurance + Short… more
- CVS Health (Raleigh, NC)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Raleigh, NC)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Raleigh, NC)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Raleigh, NC)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Gentiva (Raleigh, NC)
- …day. **Overview** The ** Medical Director ** will report directly to the National Medical Director and supervise, evaluate, and be responsible for the ... Experience demonstrated by Hospice & Palliative Medicine board certification, Hospice Medical Director Certification Board certification, or substantial practice… more
- Humana (Raleigh, NC)
- …our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates ... Medicare Advantage and Prescription Drug Plans using approximately 40...management, health outcomes, patient experience, and plan operations. The Director , Stars HOS Improvement and Operations is responsible for… more
- Surgery Care Affiliates (Raleigh, NC)
- …to policy. + Performs additional duties as directed by the CEO Administrator or Medical Director (within the scope of training). + Participates as the clinical ... all surgeries, through reading and/or attendance at local or national meetings. + Leads team through any cardiac or...Works cooperatively and communicates regularly with the CEO Administrator, Medical Director (s) of the Center and all… more
- Evolent (Raleigh, NC)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- HCA Healthcare (Marion, NC)
- …or limits? Our Mission Hospital McDowell team is looking for an Administrative Director of Quality. HCA Healthcare is an advanced healthcare network that has ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...lives across the country? Apply today to our Administrative Director of Quality and be a part of the… more
- Granville Medical Center (Oxford, NC)
- …with standards established by The Joint Commission, Centers for Medicare & Medicaid Services (CMS), hospital bylaws, departmental regulations, institutional ... policies and procedures and Standards of Nursing Practice for patient care. Director must be a positive role model by demonstrating professional practice and… more
- Humana (Raleigh, NC)
- …experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for ... starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more