- 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 ... a community hospital which is an extension of UNC Medical Center focusing on many of our elective surgical...well-being of the unique communities we serve. Summary: The Clinical Nurse IV practices at the level… more
- Fresenius Medical Center (Garner, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Cognizant (Raleigh, NC)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… 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 ... or change at any time, with or without notice. Primary Responsibilities + Independently review and analyze pre and post service medical necessity, benefit, and… 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 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Raleigh, NC)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Medical and Case Management services for Workers' Compensation. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, ... and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager.... review , continued stay reviews, and based on clinical judgment and state WCB Medical Treatment… more
- North Carolina Central University (Durham, NC)
- …and disease prevention. May supervise, teach, and evaluate students and other medical staff. Provides clinical knowledge to health-related queries from faculty ... director. Patient care is provided in an outpatient clinical setting. Nurse Practitioner may practice general...modalities. + To make accurate decisions based upon the review of patient symptoms and medical records.… 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
- Dispatch Health (Cary, NC)
- …recovery, as necessary. + Chart Review with aim to promote evidence based medical practice and adherence to DispatchHealth clinical pathways + Work as part ... Lead Nurse Practitioner or Physician Assistant FNP PA-C **How...readiness to practice during the interview process, arrange MATs ( medical assessment tool) as needed, and complete Clinical… 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 ... reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff,… more
- Humana (Raleigh, NC)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … more
- Sunrise Senior Living (Raleigh, NC)
- …is to be a part of.** **Job ID** 2025-235355 **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
- Humana (Raleigh, NC)
- …based on operational needs at the discretion of department leadership. The Telephonic Nurse provides medical guidance, assists with access to care concerns, ... medication adherence and is trained to act as a clinical concierge. The NAL Telephonic Nurse role...compliance, etc. Responsibilities include: + **Provide accurate and appropriate medical advice and right level of care guidance utilizing… more
- CenterWell (Raleigh, NC)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special… more
- Sedgwick (Raleigh, NC)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Fortune Best Workplaces in Financial Services & Insurance Professional Liability Nurse Consultant **PRIMARY PURPOSE** **:** To handle complex or high exposure… more
- Elevance Health (Durham, NC)
- …and Quality of Care cases. + Extrapolates and summarizes medical information for medical director. + Prepares nurse summaries for Quality of Care cases and ... ** Nurse Appeals RN-Quality of Care** **Hybrid 1:** This...forwards to Medical Director for review and determination. +...grievances/quality of care issues and is a resource for clinical and non- clinical team members in expediting… more
- Datavant (Raleigh, NC)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Elevance Health (Durham, NC)
- **Telephonic Nurse Case Manager II** **Sign On Bonus: $3000** **Location** : This role enables associates to work virtually full-time, with the exception of required ... different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within… more
- Griswold Home Care, Inc (Durham, NC)
- Are you looking to apply your leadership skills and clinical expertise in a dynamic and rewarding work environment? Join the Griswold team in championing ... RN Administrator, you'll play a vital role in overseeing non- medical client cases and performing ongoing care education for...the care plan to reflect any change, a documented review of the updated care plan with the caregivers,… more