... quality. Health Plan/Payer or Provider Systems experience **Preferred Qualifications ... . Position Summary The Lead Director, Network Management – Medicaid/North Carolina is accountable for ...

... is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and ... resides in North Carolina and have a NC License without encumbrances.** In the Medical Director ...

... providers. As a Medical Director you will focus primarily on overseeing utilization review / quality ... quality and effective use of health care resources. This is a remote based (work from home) role ...

... /services. Enhancement of Medical Appropriateness and Quality of Care: • Application and ... escalates quality of care issues through established channels • Ability to speak to medical and ...

... Director to brief DL, RX on key priorities and upcoming milestones. Set up video conference support and ... experience with mySchedule and Workbrain or other scheduling/time and attendance/payroll systems strongly ...

... health programs and services to its membership. Aetna is looking for a medical director to be part ... medical director is a work-at-home position located anywhere in the US. The Medical Director will ...

... office working environment with productivity and quality expectations Work requires the ability to ... includes navigating multiple systems and keyboarding Effective communication skills, both verbal and ...

... Medical Appropriateness & Quality of Care:** Application and/or interpretation of applicable criteria ... Identifies and escalates quality of care issues through established channels. Utilizes influencing ...

... ) for safe and accurate prescription fulfillment; delivering results while balancing quality and ... customer safety Administer, monitor, and react to Asset Protection programs and systems: employee bag ...

... , tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive ... utilization management, quality management, network management and clinical coverage and policies ...

... department production systems. Investigates and evaluates alternative solutions to meeting business needs. Support 1m IFP members through tightly managing vendor data quality and timeliness; ensure data is ...

... systems) to establish, oversee, and maintain provider risk management and positive relationships and ... maintain the data quality during network development lifecycle. Perform complex analysis on large data ...

... . Position Summary Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director ... . The Medical Director (Cardiology) will be a Subject Matter Expert (SME) with a background in ...

... their clinical quality and effective use of health care resources. This is a remote based (work at home) based anywhere in the US. The Medical Director (Ortho/Total Joint) will be a ...

... providers. As a Medical Director you will focus primarily on overseeing utilization review / quality ... quality and effective use of health care resources. This is a remote based (work from home) role ...