• Director Operations, Compliance & Privacy

    UNC Health Care (Morrisville, NC)
    …UNC Health physician groups, Strategy & Corporate Development, Real Estate, Revenue Cycle, Managed Care , UNC School of Medicine, and Research. + Leads people ... understanding of relevant laws, regulations, and standards that impact the health care industry. Demonstrated commitment to staying up to date on compliance,… more
    UNC Health Care (09/28/25)
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  • Pharmacist - Clinical Advisor

    CVS Health (NC)
    …of the time as required to meet business needs. **Required Qualifications** 3+ years of managed care Pharmacist experience and/or 1 year of Managed Care ... in good standing. - Demonstrated experience in a client-facing role within the managed care environment - Demonstrated understanding of and experience with… more
    CVS Health (10/08/25)
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  • Medical Director - Florida

    Humana (Raleigh, NC)
    …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
    Humana (10/03/25)
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  • Medical Director-Payment Integrity

    Humana (Raleigh, NC)
    …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized at the Inpatient… more
    Humana (09/26/25)
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  • Medical Director - Mid West Region

    Humana (Raleigh, NC)
    …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... experience, and judgement to make determinations whether requested services, level of care , and/or site of service should be authorized. All work occurs within… more
    Humana (09/16/25)
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  • Medical Director - Northeast Region

    Humana (Raleigh, NC)
    …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an… more
    Humana (07/25/25)
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  • Lead Director, Product Mgt & Development…

    CVS Health (NC)
    …open to qualified candidates within the United States. **Required Qualifications** 10+ years of Managed Care experience in health plan and/or PBM roles 10+ years ... CMS audit experience HPMS experience **Preferred Qualifications** 15+ years of Managed Care experience in health plan and/or PBM roles 15+ years Medicare… more
    CVS Health (09/24/25)
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  • Medicaid State Technology Lead

    Humana (Raleigh, NC)
    …policy administration or related field;work experience may meet this need + 5 + years managed care experience + 5 + years in Medicaid program implementation or ... and clinical operations; Medicaid preferred + Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to… more
    Humana (09/03/25)
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  • Field Medical Outcomes, Director, non

    Pfizer (Raleigh, NC)
    …as appropriate. The individual may be involved in presentations to payers, managed care organizations, formulary decision makers and regional medical advisory ... of the following: + Clinical, formulary, and/or other management experience + Managed Care , pharmaceutical industry, and/or Quality Improvement + Data Analytics… more
    Pfizer (10/02/25)
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  • Center Administrator

    CenterWell (Charlotte, NC)
    …**Preferred Qualifications** + Basic knowledge of Population Health Strategy + Medicare knowledge + Managed care experience + Value Based Care knowledge + ... TB. + Direct leadership experience and demonstrated ability to lead , coach and mentor teams + Proven interpersonal skills...of an interdisciplinary team + Solid understanding of medical care delivery, managed care financial… more
    CenterWell (08/08/25)
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