- 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
- Lincoln Financial (Raleigh, NC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... 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
- Brighton Health Plan Solutions, LLC (NC)
- …Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… 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 in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Humana (Raleigh, NC)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Winston Salem, NC)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location** : This role...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (Durham, 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:** Virtual: This role...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- CVS Health (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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit interpretation, contract ... 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… more
- Sharecare (Raleigh, NC)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- HCA Healthcare (Highlands, NC)
- …important to you, we encourage you to apply for our Case Management Registered Nurse opening. Our team will promptly review your application. Highly qualified ... colleagues in their positions. Join our Team as a(an) Case Management Registered Nurse and access programs to assist with every stage of your career. **Benefits**… 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
- UNC Health Care (Hendersonville, NC)
- …of the unique communities we serve. Job Summary The role of the Orthopedic Nurse Navigator (ONN) is that of advocate, consultant, and educator in the implementation ... their therapies and plans of care. + Participates in review of program protocols and care pathways. Serves as...areas at risk within the CJR program including SNF utilization , discharge status to home and home health, post-acute… more
- ERP International (Camp Lejeune, NC)
- …providers for 90% of all referrals. + Provides timely, descriptive feedback regarding utilization review issues. + Reviews and enters first right of refusal ... and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues...the last two years as a practical or vocational nurse . Licensure:** Current, full, active and unrestricted license as… 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
- Granville Medical Center (Oxford, NC)
- Registered Nurse - ICU Location: Granville Health System, Oxford, NC About Granville Health System: For over a century, Granville Health System has been at the ... and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members.… more
- Granville Health System (Oxford, NC)
- Registered Nurse # ICU Location: Granville Health System, Oxford, NC # About Granville Health System: For over a century, Granville Health System has been at the ... and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members.#… 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