Utilizing strong functional/technical area knowledge and expertise with relevant systems/applications. The incumbent defines, evaluates, and validates requirements, business functional design, and technical design for complex business issues within their domain areas. They act as a liaison representing their department and the processes and workings within it to develop e

Dependent on clinical discipline, the Case Manager LCSW coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/

IT is different here. Our work as technology specialists pushes the boundaries of what's possible in health care. You will build solutions that make a real difference in people's lives. Driven by the importance of their work, our team members innovate to elevate. We're encouraged to be curious, collaborate, and turn ideas into solutions that can make health care better fo

Corporate Pharmacy spearheads Blue Cross NC's prescription drug initiatives through member focused formulary design, sales team support, benefit plan creation, program development, and more. This department collaborates on innovative solutions with its pharmacy benefit manager Prime Therapeutics (Prime) and other strategic partners to deliver significant value through imp

As the Consultant, Public Affairs you will lead the enterprise business development growth and retention strategies for our commercial and government business interests coordinating across the enterprise for a comprehensive public affairs strategy Job Duties Leads a team to direct public affairs strategies focused on business development to support government and commerci

The incumbent will use coding expertise to analyze claims, medical records and supporting documentation to ensure correct coding guidelines are followed. What You'll Do Accurately assign codes to medical diagnoses and procedures. Maintain up to date knowledge of medical coding standards, including ICD 10 CM, CPT, and HCPCS. Utilize Microsoft Office Suite and medical codin

As an Enterprise Strategy Senior Consultant, you'll develop new and groundbreaking strategies to further our purpose to make health care better for all by solving complex challenges that transform health care and have a real impact on the lives of our customers and communities. The Enterprise Consulting team leads at the intersection of health care and strategy to deliver

Blue Cross and Blue Shield of North Carolina is seeking innovative thinkers and strategists who have a passion to take a hands on role in building the future model of healthcare. The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health

Blue Cross NC Corporate Pharmacy Department is seeking an Associate Vice President (AVP) for Government Pharmacy. The role involves leading teams in the Medicare Segment with plans for expansion into other Government Segments. The ideal candidate will have demonstrated experience in team leadership, product development, Utilization Management, Cost of Care, and quality st

This is a provider facing role. Evaluates and monitors provider performance to achieve excellence in risk adjustment coding. Participates in regular provider meetings and/or calls with other internal BCNC teams for collaboration on Blue Premier success. Provides timely, relevant, accurate, and objective feedback to providers, and the management team which includes a plan

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is seeking a Manager to join our growing Care Delivery Services Team! We are looking for a driven and entrepreneurial individual that is excited by a role that involves executing a strategic vision for the company. You are the art of the possible, able to successfully manage and support projects related to high

Blue Cross and Blue Shield of North Carolina's Diversified Business Group is seeking an organized, analytical, and hardworking professional to join its Corporate Development team as a Senior Strategic Advisor, Financial Monitoring and Analysis. In this newly created role, you will be tasked with developing a deep understanding of the Diversified Business Group portfolio o

Leads and manages the day to day operational and tactical aspects of all Medicare related PBM (Pharmacy Benefit Manager) activities, new initiatives, and other ongoing business deliverables in accordance with business needs. Identifies, evaluates, and resolves issues that conflict with PBM related deliverables. Collaborates closely with project team members, business owne

The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health care organizations in North Carolina and beyond. We have a history of forging forward thinking partnerships and investments with like minded partners to create the blueprint of th

The Certero Sr. Asset Management Analyst will be responsible for overseeing the life cycle planning of corporate assets through asset selection, operation, refresh, migration, optimization, retirement and disposal; including building, technology, software, furniture, fixtures and/or equipment assets. Independently perform the analysis, design and development of high volum