- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, ... changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review / Medical and Case Management services for Workers' Compensation. The Workers' ... Compensation Nurse Case Reviewer collaborates with medical care...for timely return to work. + Provides case management, utilization review , continued stay reviews, and based… more
- Fresenius Medical Center (Greensboro, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- CenterWell (Greensboro, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and performance monitoring, oversees all Workers' Compensation (WC) Case Management and Utilization Review (UR) Programs. + Collaborates with the Chief ... for the Casualty and Clinical Services departments which in turn includes Utilization Management, Case Management and Population Health divisions. The position can… more
- UNC Health Care (Chapel Hill, NC)
- …cost-effective discharge planning. + Serve as a key resource in case management, utilization review , and discharge planning. + Stay compliant with all regulatory ... assess the risk level of patients based on various factors such as medical conditions, social determinants of health, and behavioral health needs. b. Develop… more
- UNC Health Care (Chapel Hill, NC)
- …through the integrating and functions of point of entry case management, utilization review , and effective patient flow activities. Responsibilities: 1. Capacity ... tasks as appropriate. 4. Clinical Appropriateness Assessment- Using established medical necessity criteria products and departmental guidelines perform assessments… more