- 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based guidelines, policies ... Duties as assigned. Essential Qualifications * Current Licensed Practical Nurse (LPN) or Registered Nurse ...within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience… 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
- 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
- UNC Health Care (Chapel Hill, NC)
- … Nurse Practitioner, Physician Assistant, Clinical Pharmacist Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist) in the ... **Description** Have you considered a Neonatal Nurse Practitioner career with UNC Health? This opportunity...At all times care will be provided through independent utilization of approved protocols and procedures and under the… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …assurance standards and MagnaCare policies and procedures. Essential Qualifications + Currently licensed Registered Nurse in the state of NY, or the ability to ... management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines. + Knowledgeable and compliant… more
- UNC Health Care (Chapel Hill, NC)
- …of professional nursing. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... of the unique communities we serve. Summary: The Transplant Nurse Coordinator (TNC) is responsible for coordinating the total...for both patient and graft survival. Reviews patient resource utilization with administrative and clinical staff to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …in all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse (RN), Nurse Practitioner (NP), or Physician Assistant ... more effective and affordable and will be responsible for the Casualty and Clinical Services departments which in turn includes Utilization Management, Case… 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
- UNC Health Care (Chapel Hill, NC)
- …lead a skilled group of care managers and social workers. Candidates must be a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW). Preference ... Care Management Department team(s). Provides management direction to Case Managers, Utilization Managers, Clinical Social Workers, Clinical Authorization… more
- Granville Medical Center (Oxford, NC)
- Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About Granville Health System: For over a century, Granville Health System ... with both professional and personal fulfillment. Position Overview: A professional Registered Nurse (RN), caregiver who assumes responsibility and accountability… 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 (Chapel Hill, NC)
- …major in nursing within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North ... Experience Requirements:** * Minimum of 2 years of experience as a registered nurse . **Knowledge/Skills/and Abilities Requirements:** * * Strong knowledge of… 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 (Chapel Hill, NC)
- …degree in Nursing **Licensure/Certification Requirements:** * Must be licensed to practice registered nurse in the state of North Carolina **Professional ... the integrating and functions of point of entry case management, utilization review, and effective patient flow activities. Responsibilities: 1. Capacity Planning-… 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 (Chapel Hill, NC)
- …of professional nursing. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... maximizing the outcomes for both patient and graft survival. Reviews patient resource utilization with administrative and clinical staff to identify areas for… more