- Humana (Raleigh, NC)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Veterans Affairs, Veterans Health Administration (Pembroke, NC)
- …under Behavioral Health Service Line - Social Work Division. The Caregiver Support Senior Social Worker is assigned to the CSP with responsibility to provide ... Total Rewards of a Allied Health Professional The Caregiver Support Senior Social Worker develops and implements the Caregiver Support Program specific… more
- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Raleigh, NC)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Evolent (Raleigh, NC)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Raleigh, NC)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Novant Health (Charlotte, NC)
- Job Summary The Senior Director of System Respiratory Care provides executive leadership across all markets, overseeing the strategic planning, direction, and ... services. Working in close collaboration with directors and managers, the Senior Director ensures system-wide consistency, fostering alignment and integration across… more
- LifePoint Health (Henderson, NC)
- …ensure appropriate evolution of bylaws to meet health delivery, regulatory and accreditation imperatives Risk management Oversight of select service lines ... and analyze data to plan, recommend and direct opportunities to evaluate utilization of hospital resources and facilitate Medical Staff changes in practice to… more
- Evolent (Raleigh, NC)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more
- Novant Health (NC)
- …communication skills. Skills in establishing and maintaining effective relationships with Senior Management and Leaders within Novant Health, physicians, ... procedures, the guidelines of the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), the legal requirements of… more