- 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)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… 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
- 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
- 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)
- …our caring community and help us put health first** The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new ... and work is performed without direction. The Behavioral Health Medical Director actively uses their medical...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- LifePoint Health (Rutherfordton, NC)
- …to clinical resource management, discharge planning activities, patient advocacy, clinical social work and best practice in medical necessity determination ... services in a caring, professional environment through the teamwork of our medical staff and employees. Rutherford Regional Health System's partnership with Duke… more
- Edwards Lifesciences (Concord, NC)
- …to our aligned business partners including sales, marketing, government affairs, and medical / clinical affairs. + Assist our Regional and Territory Sales Managers ... us and be part of our inspiring journey. The Director , Global Health Economics and Reimbursement is a field...industry. Reimbursement and/or sales experience preferred. + Understanding of medical and clinical research methods and publication… 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
- Cardinal Health (Raleigh, NC)
- The Director , Channel Development Strategy- Diabetes for Cardinal Health's at-Home Solutions is responsible for providing enhanced relationship management for ... supply chains across public and private sectors, specifically including Medicare DMEPOS reimbursement landscape. + Comprehensive communication and negotiating skills… 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 (Boone, NC)
- …position requires sitting on-site at our Boone, NC branch location.** 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 ... as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more
- Gentiva (Mooresville, NC)
- …care. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. + Utilize a variety ... lives every day. **Overview** We are looking for a ** Clinical Care Coordinator** to join our team. This position...our team. This position will directly report to the Director Contact Centerand is responsible for being highly knowledgeable… more
- Motion Recruitment Partners (Durham, NC)
- … necessity of the treatment. Refers cases that do not meet criteria to the Medical Director with appropriate clinical analysis and summaries. Issues denials ... and/or appropriate reimbursement allowances for complex claims and/or products by using clinical experience, medical literature, medical records, certificate… more
- CenterWell (Gastonia, NC)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Inc., is the new brand for a primary care medical group practice with centers open or opening in...strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing… 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