• Medicaid Drug Strategy Pharmacist Lead

    CenterWell (Raleigh, NC)
    …Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care , PBM, market and regulatory insights to develop, and/or ... lines of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights...at the center. As the nation's largest provider of senior -focused primary care , one of the largest… more
    CenterWell (08/20/25)
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  • Formulary and Medical Strategies Senior…

    Humana (Raleigh, NC)
    …the Medicaid line of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights to support the implementation of ... caring community and help us put health first** The Senior Professional collaborates with healthcare professionals, pharmacists, and other...degree or equivalent + 3+ years of experience in managed care or other pharmacy related field… more
    Humana (08/20/25)
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  • Senior Professional Business Intelligence…

    Humana (Raleigh, NC)
    … Professional Business Intelligence Engineer** is an experienced individual with broad Medicaid Managed Care expertise, deep analytics expertise, and ... intelligence, data systems, reporting and data analysis + 3+ years of health care experience for Medicare and/or Medicaid populations + Proven experience with… more
    Humana (08/27/25)
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  • Revenue Cycle Representative Senior…

    UNC Health Care (Smithfield, NC)
    …UNC Health Care 's mission and philosophy. Responsibilities: 1. Appeals & Managed Care Escalations: Project Manage all 3rd party appeals including researching ... the unique communities we serve. **This Revenue Cycle Rep Senior will be an onsite position in Smithfield, NC.**...regulatory and coding guidelines/policies. Facilitate monthly Provider Calls and Managed Care Escalations. 2. Training & Backup:… more
    UNC Health Care (08/27/25)
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  • Senior Coordinator, Individualized…

    Cardinal Health (Raleigh, NC)
    …familiar with long- and short-range changes in the reimbursement environment including Medicare, Medicaid , Managed Care , and Commercial plans while planning ... Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain...serves as the first line of communication for Health Care Providers who require special handling. The position is… more
    Cardinal Health (08/20/25)
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  • Senior Accreditation Utilization Management…

    Humana (Raleigh, NC)
    …is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care , Medicaid health plan experience **Additional Information** + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in a team...serve to achieve their best health - delivering the care and service they need, when they need it.… more
    Humana (09/03/25)
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  • Senior Clinical Programs Pharmacist

    CenterWell (Raleigh, NC)
    …and/or Medicaid experience + 3 or more years clinical experience in managed care + Ability to manage end-to-end-processes + Understand Humana's business ... put patients at the center. As the nation's largest provider of senior -focused primary care , one of the largest providers of home health services, and fourth… more
    CenterWell (08/08/25)
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  • Senior Manager, Network Management,…

    CVS Health (Raleigh, NC)
    …and/or Medicaid knowledge * 5+ years related experience, proven and proficient managed care network negotiating skills. * 3+ years contracting for large ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations,… more
    CVS Health (09/02/25)
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  • Insurance Strategy Consultant

    Humana (Raleigh, NC)
    …in a management field + Prior healthcare industry experience, preferably in the managed care or provider sector **Reporting Relationships** The role reports to ... company's total revenue and earnings. Team members partner with senior leaders of the business unit, and more broadly...serve to achieve their best health - delivering the care and service they need, when they need it.… more
    Humana (08/29/25)
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