- Fresenius Medical Care (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 operations. ... or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Raleigh, NC)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Raleigh, NC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Raleigh, NC)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Raleigh, NC)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non- Clinical support staff. The ideal candidate ... will have a strong clinical background within a managed care setting including a...Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical ... timely and accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and accreditation requirements from… more
- Evolent (Raleigh, NC)
- …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 ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Garner, NC)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… 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 ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… 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 ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …practice is defined in the four (4) dimensions outlined in the Nurse Qualification Standards. PRACTICE (Ethics, Resource Utilization ) ETHICS: Provides leadership ... matrix Demonstrated ability to coordinate and evaluate integrated programs Demonstrated clinical excellence in management of groups Demonstrated knowledge of… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Care System is looking to fill one (1) full time Registered Nurse vacancy for the Referral Coordinator Team. Responsibilities Job Description/Scope of Practice ... the scheduling of referral appointments. This change shifts the work of multiple clinical staff members to Referral Coordination Teams (RCT) of administrative and … more
- CVS Health (Raleigh, NC)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in ET zones **Education**… more
- UNC Health Care (Chapel Hill, NC)
- …serve. The individual selected for this position will function as a Neonatal Nurse Practitioner (NNP) delivering critical care medical management in the Newborn ... by identifying and implementing processes for improvement. Consults with management in assessment, problem-solving, decision-making, and evaluating clinical… more
- CVS Health (Raleigh, NC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …VA Healthcare System is seeking (1) highly skilled/experienced Registered Nurse to serve within Medicine (Specialty Clinics). Demonstrates leadership, ... experience/ingenious approaches to management of complex patient care. Accountable for the ...congestive heart failure and other chronic diseases. The Registered Nurse within these clinics which includes Cardiology, Dermatology, Gastroenterology,… 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' ... services for timely return to work. + Provides case management , utilization review, continued stay reviews, and...utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines. +… more
- Highmark Health (Raleigh, NC)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
