- 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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… 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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… 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
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… more
- Datavant (Raleigh, NC)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
- Brighton Health Plan Solutions, LLC (NC)
- …other assigned duties to meet required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight and ... Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national… more
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