- Centene Corporation (Raleigh, NC)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality ... AND reside in North Carolina + American Board Certification + Utilization Management experience and knowledge of quality accreditation standards highly preferred… more
- RxBenefits (Charlotte, NC)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- Humana (Raleigh, NC)
- …of program changes and outcomes. Responsibilities include: + Oversee the development, review , and maintenance of Utilization Management (UM) policies and ... ranging from moderate to substantial. The Policy Governance Lead for Utilization Management (UM) is responsible for overseeing the development, implementation, and… more
- CenterWell (Youngsville, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... **Branch Location** : Youngsville, NC **This is not a remote or work-from-home position. This position requires you to...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Humana (Raleigh, NC)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Olsson (Raleigh, NC)
- BMS Engineering Leader - Data Center Arizona - Remote ; Arkansas - Remote ; Florida - Remote ; Georgia - Remote ; Idaho - Remote ; Illinois - Remote ; ... Remote ; Iowa - Remote ; Kansas - Remote ; Kentucky - Remote ; Louisiana - ...Monitor and enhance the group's project performance and employee utilization and workload, identifying potential areas of improvement and… more
- Kemper (Raleigh, NC)
- Location(s) Remote -AL, Remote -CT, Remote -FL, Remote -GA, Remote -IL, Remote -IN, Remote -MI, Remote -NC, Remote -OH, Remote -PA, ... complex technical problems and issues with assigned applications and work processes. + Review and recommend test plans for impacted areas and end to end test… more
- Battelle Memorial Institute (Fort Bragg, NC)
- …strength and conditioning equipment + Participate in periodic meetings to review and evaluate physical training programs and identify opportunities for improvement. ... + Perform administrative duties such as maintaining records of utilization , workload, conducting or participating in education programs, and...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Centene Corporation (Raleigh, NC)
- …needing care within the urban and rural populations + Compile and review reports on work function activities for statistical, financial and process improvement ... trends, assist in financial forecasting, and make recommendations to management + Review analyses of activities, costs, operations and forecast data to determine… more
- CenterWell (Raleigh, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… more