- BlueCross BlueShield of North Carolina (NC)
- **Job Description** Join our team as Director , Actuarial Services - Medicare Pricing and lead our Medicare pricing function for all Blue Cross NC Medicare ... a team of actuaries responsible for pricing, forecasting, and strategic support of Medicare Advantage, Medicare Supplement, and Part D (PDP) products. + Oversee… more
- CenterWell (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Raleigh, NC)
- **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 ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Raleigh, NC)
- …"base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… more
- Merck (Raleigh, NC)
- …with HSO MADs + Serves as a resource for the PM MAD-HSO Team Lead, HSO Executive Director Medical Affairs, and other members of US Medical Affairs on other ... **Job Description** + The Precision Medicine - Medical Affairs Director - Health Systems...research \#eligibleforERP **Required Skills:** Benefit Programs, Clinical Data, Clinical Pharmacy , Clinical Studies, Medical Affairs, Medical… more
- Centene Corporation (Raleigh, NC)
- …benefits including a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director in North Carolina.** Centene Corporation is a leading ... outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and … more
- Centene Corporation (Raleigh, NC)
- …of performance improvement initiatives for network providers. + May assist Chief Medical Director in planning and establishing goals and policies to ... committees including committee structure, processes, and membership. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and … more
- Grifols Shared Services North America, Inc (Research Triangle Park, NC)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- BrightSpring Health Services (Conover, NC)
- …with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case ... nursing and direct care staff, family and/or guardians, and community medical providers and professional consultants in cooperation with operations management +… more
- CenterWell (Charlotte, NC)
- …participant and lead with the care team through daily huddles. + Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of ... to write prescriptions under the authority of a collaborating physician/ medical director . + This role is considered...and unrestricted DEA license (or must obtain one) + Medicare Provider Number/ Medicaid Provider Number + Experience managing… more
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