- Humana (Raleigh, NC)
- …site of service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Sumitomo Pharma (Raleigh, NC)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... track record of detailed, medically accurate, and scientifically relevant writing and review skills in line with compliance requirements. + Experience… more
- Evolent (Raleigh, NC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...review process to reflect appropriate utilization and … more
- Evolent (Raleigh, NC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD ... setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in...review process to reflect appropriate utilization and … more
- Otsuka America Pharmaceutical Inc. (Raleigh, NC)
- …+ Ensure all omnichannel activities adhere to internal medical , legal, and regulatory standards. + Collaborate with Compliance and Legal to maintain robust ... Experience working within a matrixed environment. + Knowledge of pharmaceutical legal, regulatory , and medical processes. + Strong matrix team-building skills, a… more
- Evolent (Raleigh, NC)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...MD review process to reflect appropriate utilization and … more
- Evolent (Raleigh, NC)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, MSK Surgery you will be a specialty...MD review process to reflect appropriate utilization and … more
- Evolent (Raleigh, NC)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...MD review process to reflect appropriate utilization and … more
- IQVIA (Durham, NC)
- …Serve as a resource for the department, ensuring scientific integrity and regulatory compliance in the application of statistical methodology to clinical ... preparing/reviewing integrated clinical and statistical reports, and responding to regulatory queries. **Key Responsibilities:** **Leadership:** - Serve as a… more
- Evolent (Raleigh, NC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD ... reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...review process to reflect appropriate utilization and … more