- Highmark Health (Raleigh, NC)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Raleigh, NC)
- …reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Raleigh, NC)
- …reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Elevance Health (Durham, NC)
- …Accounts Medical Director ** is responsible for serving as the Operational Medical Director for our care management models for our National Account ... we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and… more
- Evolent (Raleigh, NC)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Humana (Raleigh, NC)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
- Genesis Healthcare (Pembroke, NC)
- …flexibility (no weekends or on call)! We are seeking a Fee-For-Service Attending Physician/ Medical Director for our Pembroke Center, located in Pembroke, NC. New ... grads are welcome to apply. This is a Dual Role Attending Physician/ Medical Director . It is clinical in nature. Must be BC/BE Internal Medicine or Family… more
- Select Medical (Greensboro, NC)
- …Calendar + Receiving and reviewing quarterly quality improvement reports. + Assisting the Medical Director and Quality Program Director with development and ... **Overview** **$10,000 Sign-On Bonus** **Critical Illness Recovery Hospital** ** Director of Quality Management ** At Select...** At Select Specialty/Regency Hospitals, a division of Select Medical , we care for chronically and critically ill or… more
- Humana (Raleigh, NC)
- … medical management operational improvements, including those within the medical director area + Participate in call rotation + Develop collaborative ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more