- 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)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… 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)
- … 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
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- North Carolina Agriculture & Technical State Unive (Greensboro, NC)
- …at the rank of Clinical Associate Professor or above, and reports to the Program Director . The Medical Director supports the PA and actively participates in ... well as the ARC -PA Standards of accreditations. The Medical Director will also serve as an...Nursing, Psychology, Social Work, Sociology, Speech, and Health Services management . The College is also home to three graduate… more
- UNC Health Care (Chapel Hill, NC)
- …0.25 FTE administrative role and reports to the UNC HCS Executive Medical Director for Capacity Creation & Management , while partnering with the Executive ... **Description** **Position Summary** The Executive Medical Director for the East Region...accelerate process pace related to patient flow and capacity management + Serves as a role model by demonstrating… more
- Humana (Raleigh, NC)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more