- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling… more
- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- LifePoint Health (Louisburg, NC)
- …Case Management Department to facilitate timely discharge planning.. Reports to: Director , Case Management What we offer Fundamental to providing outstanding ... Registered Nurse (RN) Utilization Review Job Type: Full Time | Day...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate use of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced ... and cost-appropriate DC planning. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight and… more
- Evolent (Raleigh, NC)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… 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 ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Raleigh, NC)
- …The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director ... role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus… more
- Evolent (Raleigh, NC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Raleigh, NC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a specialty match...cases. you will be a key member of the utilization management team. We can offer you… more
- United Therapeutics (Raleigh, NC)
- …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more
- CBRE (Raleigh, NC)
- Executive Director , Operations Management - OnDemand & Variable Tech Job ID 220744 Posted 11-Jul-2025 Service line GWS Segment Role type Full-time Areas of ... Interest Facilities Management Location(s) Remote - US - Remote - US...technicians and 3P service providers, ensuring optimal route planning, utilization , and service quality across all geographic regions. +… more
- Grant Thornton (Raleigh, NC)
- …to share strategy, to implement process improvements and to roll out capacity management strategies to maximize utilization and drive operational excellence + ... Grant Thornton is seeking an Advisory Capacity & Resource Management (C&RM) Leader to join the team. Approved office...on yearly budget planning for headcount, gross charge hours, utilization , and leverage. You will lead your team to… more
- Humana (Raleigh, NC)
- …provider population health programs focused on Stars, HEDIS, MRA, chronic condition management , and other efforts to reduce avoidable utilization * Supporting ... community and help us put health first** The Clinical Director is a key member of the regional clinical...performance, and coordinating with cross-functional teams to drive quality, utilization , and cost-of-care outcomes. At the core, this is… more
- Evolent (Raleigh, NC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Raleigh, NC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. We can offer you a… more
- Humana (Raleigh, NC)
- …We are seeking an experienced and strategic leader to fill the position of Director of Internal Pharmacy Forecasting and Performance Analytics. This role will lead a ... of five direct reports and 1-2 indirect reports. The Director will play a key role in driving business...modeling skills to forecast pharmacy volume, inform mail order utilization expectations for CMS bid, and understand utilization… more
- CBRE (Raleigh, NC)
- Business Development Senior Director , Enterprise Occupier Solutions Job ID 208590 Posted 28-Feb-2025 Service line GWS Segment Role type Full-time Areas of Interest ... **The client-facing title for this role is Senior Managing Director , Business Development** We are seeking a Senior ...and grow activities in integrated Real Estate and Facilities Management outsourcing pursuits, and will lead interactions in a… more
- Evolent (Raleigh, NC)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more