- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Elevance Health (Winston Salem, NC)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Location:** Within 50 miles...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- Evolent (Raleigh, NC)
- …Stay for the culture. **What You'll Be Doing:** Job description: As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Raleigh, NC)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... paralytic drug administration. The unit is staffed with a nurse patient ratio of 1:1 to 1:3 depending upon...clinical expertise to improve quality of care and resource utilization at the expert level with improved outcomes beyond… more
- UNC Health Care (Hendersonville, NC)
- …care and cost effectiveness through the integrating and functions of care management, utilization review and discharge planning. The Care Manager must be highly ... based on approved criteria and standards per the Hospital Utilization Review Plan. Directs delivery of notifications...+ Must be licensed to practice as a Registered Nurse in the state of North Carolina or one… more
- CVS Health (Raleigh, NC)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Sharecare (Raleigh, NC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- HCA Healthcare (Asheville, NC)
- …opportunity compelling, we encourage you to apply for our Home Care Registered Nurse Coordinator PACE opening. We promptly review all applications. Highly ... each individual is recognized. Submit your application for our Home Care Registered Nurse Coordinator PACE (Program of All Inclusive Care for the Elderly) opening… more
- LifePoint Health (Henderson, NC)
- …interpersonal skills. Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party ... Registered Nurse Case Manager Job Type: Part-Time |Days Your...an employee but as a person. As a registered nurse (RN) joining our team, you're embracing a vital… more
- LifePoint Health (Henderson, NC)
- …interpersonal skills. Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party ... Registered Nurse (RN) Job Type: Part-Time | 10-hour shifts...an employee but as a person. As a registered nurse (RN) joining our team, you're embracing a vital… more
- LifePoint Health (Henderson, NC)
- …interpersonal skills. Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party ... *Registered Nurse Case Manager* *Job Type: PRN* *Your experience...an employee but as a person. As a Registered Nurse (RN) joining our team, you're embracing a vital… more
- Lincoln Financial (Raleigh, NC)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent (Raleigh, NC)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Highmark Health (Raleigh, NC)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- HCA Healthcare (Asheville, NC)
- …Home Health Aides, Homecare Services Non-Skilled Aides and the Homecare Schedulers. Utilization of nursing skills to assess participants in their home environment ... . Must have and maintain current licensure as registered nurse with the North Carolina Board of Nursing. Compact...for our Home Care Clinical Coordinator opening. We promptly review all applications. Highly qualified candidates will be contacted… more
- Fresenius Medical Center (Plymouth, NC)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Fresenius Medical Center (Garner, NC)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- UNC Health Care (Smithfield, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new...from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the meeting to… more