- Duke Health (Durham, NC)
- …Quality of Life: Living in the Triangle! Relocation Assistance (based on eligibility) Clinical Nurse II- Duke Children's at Creekstone Location: 4709 Creekstone ... Dr, Durham, NC 27703 Job Summary: We are seeking a Clinical Nurse II in our Duke Children's Specialty Creekstone clinic located in Durham, NC to be an integral… more
- Nash UNC Health Care (Raleigh, NC)
- …includes public or private universities, colleges, community colleges, etc. Registered Nurse 2 or more years' experience in infection prevention preferred. A ... (for public reporting) and internal leadership reporting. Perform surveillance and review /evaluate cases of infections for opportunities in patient care. Provide… more
- Actalent (Durham, NC)
- Job Title: Clinical Review Nurse - Prior Authorization Location: Remote (this position is looking for east coast nurses who would be willing to help out the ... 8:00 AM-5:00 PM PST (occasional weekend/holiday rotation) Position Summary The Clinical Review Nurse will conduct medical necessity reviews for prior… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Administration Service. Responsibilities Job Description/ Scope of Practice: The Registered Nurse for Clinical Documentation Improvement (CDI) has a specific ... in Health Administration Service. The practice of the registered nurse in this position is accountable for using a...facility and VISN as appropriate. The incumbent possesses current clinical knowledge to efficiently and concurrently review … more
- UNC Health Care (Hillsborough, NC)
- …at 430 Waterstone Drive, Hillsborough, NC and offers free parking for employees. The Clinical Nurse IV, RN, position is for the 25-bed surgical unit. This ... Groups + Performance Improvement Projects/Teams & Role + Peer Review and/or Recruitment & Retention Activities + Presentations +...well-being of the unique communities we serve. Summary: The Clinical Nurse IV practices at the level… more
- Cognizant (Raleigh, NC)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- Evolent (Raleigh, NC)
- …clients as scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …(UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting ... UM/Appeals regulatory guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit… more
- Elevance Health (Durham, NC)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Justice, Bureau of Prisons/Federal Prison System (Butner, NC)
- …Level 3 Facility, or Federal Correctional Complexe (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities through data ... Utilization Review Committee. Applies predetermined evidence-based criteria sets and clinical practice guidelines when reviewing patient care in an effort to… more
- Fresenius Medical Center (Garner, NC)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Knightdale, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- UNC Health Care (Raleigh, NC)
- … nursing care consistent with professional standards. Reporting and accountable to the Nurse Manager/Director, the Clinical Nurse is responsible for ... date: September 2025 - March 2026, the New Graduate Nurse Program will offer varied start dates based on...and confidence in the professional role. In addition to clinical orientation on the unit, the Residency program provides… more
- PruittHealth (Durham, NC)
- ** CLINICAL COMPETENCY COORDINATOR / NURSE EDUCATOR.** **Join the PruittHealth family, where the health and safety of our workforce is our top priority!** We're ... provided to patients is determined by assessing competency of clinical staff on an ongoing basis, evaluating care provided...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… more
- Sharecare (Raleigh, NC)
- … helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Dispatch Health (Raleigh, NC)
- **How You'll Make an Impact** DispatchHealthis looking for a Lead Nurse Practitioner/Physician Assistant (Advanced Practice Provider or APP) to join our growing ... clinical team in **Raleigh Durham, NC** . **_There is...APP coaching and service recovery, as necessary. + Chart Review with aim to promote evidence based medical practice… more
- Sunrise Senior Living (Raleigh, NC)
- …is to be a part of.** **Job ID** 2025-234685 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents and ... administration, communication with resident support services and families, and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …disability services for timely return to work. + Provides case management, utilization review , continued stay reviews, and based on clinical judgment and state ... About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Workers' Compensation. The Workers'… more
- CVS Health (Raleigh, NC)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- BAYADA Home Health Care (Raleigh, NC)
- …is seeking a Registered Nurse (RN) to fill the position of **RN Clinical Manager** for our Raleigh, NC Medicare Certified Senior Living home health office. This ... clients living in Senior Living Communities. **As an RN Nurse Manager your day may look like this!** +...and support business growth. + Management and mentoring of Clinical Associates and field staff + Facilitate new hire… more
