- Brighton Health Plan Solutions, LLC (NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... coverage while working remotely. Primary Responsibilities * Performs clinical utilization reviews using evidenced based guidelines, policies and nationally… more
- CVS Health (NC)
- …And we do it all with heart, each and every day. Requisition Job Description Utilization Management is a 24/7 operation and work schedule may include weekends ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… 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
- Lincoln Financial (Raleigh, NC)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of...Health Entity: UNC Lenoir Health Care Organization Unit: Care Management Work Type: Full Time Standard Hours Per Week:… more
- Brighton Health Plan Solutions, LLC (NC)
- About The Role The Manager, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the...Qualifications + Active and unrestricted license as a Registered Nurse (RN) + Bachelor's degree in nursing, (or equivalent… more
- Elevance Health (Winston Salem, NC)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... to 6:30 PM Eastern. Training hours may vary. The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Durham, NC)
- ** Utilization Management Representative II** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required ... shift between 8 am - 8 pm EST. The ** Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Centene Corporation (Raleigh, NC)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Sharecare (Raleigh, NC)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- HCA Healthcare (Asheville, NC)
- …about delivering patient-centered care?** Submit your application for Care Manager Registered Nurse position and spend more time at the bedside with the patient. ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Mission Hospital! **Job Summary… more
- HCA Healthcare (Highlands, NC)
- …Hospital we support our colleagues in their positions. Join our Team as a(an) Case Management Registered Nurse and access programs to assist with every stage of ... more affordable to gain certifications and job skills. Apply today for our Case Management Registered Nurse opening and continue to learn! **Job Summary and… more
- Veterans Affairs, Veterans Health Administration (Salisbury, NC)
- …responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers ... guidance in how to improve care provided to residents and families. The nurse will assist in directing the provision of nursing education, orientation, competencies… more
- Veterans Affairs, Veterans Health Administration (Salisbury, NC)
- …education, orientation, competencies, and providing quality improvement and outcomes utilization . The Endoscopy Nurse administers medications and procedures ... Summary The Registered Nurse (Endoscopy) is responsible for providing competent, evidence-based...responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice… more
- CVS Health (NC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Pediatrics, **Oncology** or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or … more
- ERP International (Cherry Point, NC)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International is seeking full-time **Registered Nurse (RN) Case Manager** in support of theNaval Health Clinic Cherry Point, NC. Apply online today… 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
- 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 Appeal ... and Grievance Nurse is responsible for conducting daily clinical and benefit...accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and… more
- AdventHealth (Fletcher, NC)
- **Registered Nurse Case Manager -** **AdventHealth Home Health** **All the benefits and perks you need for you and your family:** + Sign On Bonus *Up to $5000 + ... Counties.** **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional nurse...needs. The RN Care Manager is responsible for independent management of the Home Health patient population requiring the… more