- 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Raleigh, NC)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Raleigh, NC)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… 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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Raleigh, NC)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Raleigh, NC)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Evolent (Raleigh, NC)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... 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 Cardiology, Field Medical Director you will be a key member of the utilization management ... team . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… 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 ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Centene Corporation (Raleigh, NC)
- …of performance improvement initiatives for network providers. + May assist Chief Medical Director in planning and establishing goals and policies to ... 28 million members as a clinical professional on our Medical Management/Health Services team . Centene is a...healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals… more
- Evolent (Raleigh, NC)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Granville Medical Center (Oxford, NC)
- Director , Women's Services Location: Granville Health System, Oxford, NC About Granville Health System: For over a century, Granville Health System has been at the ... Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main… more
- Elevance Health (Cary, NC)
- **CFSP Director Substance Use Disorder Programs & Services** **$5000 Sign-On Bonus** We are partnering with North Carolina DHHS to operationalize a statewide ... Medicaid Plan designed to support Medicaid -enrolled infants,...accommodation is granted as required by law. The **CFSP** ** Director Substance Use Disorder Programs & Services** is responsible… more
- Danaher Corporation (Raleigh, NC)
- …that improve patient outcomes across a range of settings. As a member of our team , you can make an immediate, measurable impact on a global scale, within an ... the Danaher Business System which makes everything possible. The Field Reimbursement Director position is a provider / customer facing role responsible for… more
- Grifols Shared Services North America, Inc (Research Triangle Park, NC)
- Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global ... and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing… more
- Humana (Raleigh, NC)
- …to put those customers at the center of everything it does. The Director , Data Technology Solutions devises an effective strategy for executing and delivering on ... IT business initiatives. The Director , Data Technology Solutions requires an in-depth understanding of how organization capabilities interrelate across the function… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Associate Director , Business Intelligence solves complex business problems and issues using data from ... external sources to provide insight to decision-makers. The Associate Director , Business Intelligence requires a solid understanding of how...applications, and data resources. The role will lead a team of up to approx. 7-9 direct associates. **Key… more
- Granville Medical Center (Oxford, NC)
- …training is usually required. Strong communication skills both written and oral, team player. Medicare and Medicaid regulatory knowledge a must. Preferred: ... Granville Health System. Coordinates operations with other hospital units and medical staff. Interprets policies and recommends changes to administration. Interviews… more
- Baylor Scott & White Health (Raleigh, NC)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare/ Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the..., Denial Resource Center will lead a highly skilled team of Registered Nurses, Certified Coding Specialists, Complex Appeal… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** Associate Director of Project Management to join the Readiness and Recovery team , focusing ... experiences, drive transformation, and support enterprise goals. The Associate Director will ensure alignment of project initiatives with business objectives,… more