- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based guidelines, policies and nationally… more
- CVS Health (Raleigh, NC)
- …with occasional holiday rotation. **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience ... it all with heart, each and every day. **Position Summary** Medicare Precertification Nurse Consultant position: _Utilization Management is a 24/7 operation 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 EST/CST zones… more
- CenterWell (Raleigh, NC)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Raleigh, NC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… more
- CVS Health (Raleigh, NC)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Care System is looking to fill one (1) full time Registered Nurse Manager vacancy for the Emergency Department service line. Responsibilities Job Description/Scope ... Psychiatry Emergency Care staff, and Medical Support Assistants. The work of the Nurse Manager is supported by an excellent administrative staff, including a Quality… more
- Veterans Affairs, Veterans Health Administration (Garner, NC)
- …enter and retrieve data. Prior experience with determining patient assignments, unit management and charge nurse responsibilities. Preferred Level of Education ... Durham VA Health Care System is looking to fill several full time Registered Nurse vacancies for the Garner VA Outpatient Clinic - Patient Aligned Care Team.… 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' ... and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager....services for timely return to work. + Provides case management , utilization review, continued stay reviews, and… 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 ... **Description** Have you considered a Neonatal Nurse Practitioner career with UNC Health? This opportunity...standards. The practitioner has responsibility for complete daily medical management of a caseload of critically ill newborn infants… more
- Highmark Health (Raleigh, NC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Durham, NC)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Evolent (Raleigh, NC)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- CVS Health (Raleigh, NC)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the… more
- Fresenius Medical Center (Knightdale, NC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- UNC Health Care (Chapel Hill, NC)
- …**Professional Experience Requirements:** * Five (5) years of experience in care management , utilization management , discharge planning, care coordination, ... operations for designated Clinical Care Management Department team(s). Provides management direction to Case Managers, Utilization Managers, Clinical Social… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …for the Casualty and Clinical Services departments which in turn includes Utilization Management , Case Management and Population Health divisions. ... + Strong skills in management of a clinical team. + Previous Utilization Management experience required. + Previous experience in Case Management … more
- UNC Health Care (Chapel Hill, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... planning. + Serve as a key resource in case management , utilization review, and discharge planning. +...7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North… more