- Cognizant (Raleigh, NC)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Raleigh, NC)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Raleigh, NC)
- …/benefit management function. **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure ... all with heart, each and every day. **Position Summary** Medicare Precertification Nurse Consultant position: _Utilization Management is a 24/7 operation and work… more
- CVS Health (Raleigh, NC)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient… 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
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Influences care outcomes by collaborating with members of interdisciplinary team. The Oncology/Hematology Registered Nurse (RN) is a clinical expert who uses ... The Durham VA Healthcare System is seeking (1) highly skilled/experienced Registered Nurse to serve within Hematology/Oncology Services. Demonstrates leadership,… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …The Durham VA Health Care System is looking to fill one (1) full time Registered Nurse (Care Manager) vacancy for the Patient Aligned Care Team. Responsibilities ... irrigations and education related to disease/self-management and equipment The Registered Nurse in this position will serve...presenting to the clinic and via the telephone. The clinical nurse will coordinate care through the… more
- UNC Health Care (Smithfield, NC)
- …of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Raleigh, NC)
- …a member's overall wellness through integration. - Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and ... functions as well as smooth transition to programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Durham VA Health Care System is looking to fill one (1) full time Registered Nurse Manager vacancy for the Emergency Department service line. Responsibilities ... an excellent administrative staff, including a Quality Consultant, a Clinical Nurse Educator, and an Administrative Officer...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Sharecare (Raleigh, NC)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- CenterWell (Lillington, NC)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... on-site at our Lillington, NC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient...A minimum of 2 years of experience as a Registered Nurse (RN). + Previous experience in… more
- Deloitte (Raleigh, NC)
- …certification a plus (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM) + Experience as clinical registered nurse , physician, physician assistant, case manager, ... or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical ...clinical documentation specialist, utilization review, informatics RN, Quality, DRG Validation and health… more
- Datavant (Raleigh, NC)
- …clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- UNC Health Care (Morrisville, NC)
- …major in nursing within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North ... self-management. 3. Risk Segmentation: a. Utilize standardized tools and clinical judgment to identify and assess the risk level...* Minimum of 2 years of experience as a registered nurse . **Knowledge/Skills/and Abilities Requirements:** * *… more
- UNC Health Care (Raleigh, NC)
- …in Nursing; Licensure/Certification Requirements: * Must be licensed to practice as a registered nurse in the state of North Carolina Professional Experience ... the integrating and functions of point of entry case management, utilization review, and effective patient flow activities. Responsibilities: 1. Incoming Transfer… more
- Highmark Health (Raleigh, NC)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- UNC Health Care (Raleigh, NC)
- …Nursing **Licensure/Certification Requirements:** * Must be licensed to practice as a registered nurse in the state of North Carolina **Professional Experience ... appropriate patient flow and bed planning with a focus on increasing bed utilization and reducing patient/bed turnaround delays with a decrease in length of stay… more