- Evolent (Raleigh, NC)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Elevance Health (Durham, NC)
- ** Nurse Reviewer I** A proud member...reviews that are routine having limited or no previous medical review experience requiring guidance by more ... Hours:** **Monday through Friday, 9:30AM - 6PM (CST).** The ** Nurse Reviewer I** is responsible for conducting...+ Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request… more
- UNC Health Care (Hillsborough, NC)
- …at 430 Waterstone Drive, Hillsborough, NC and offers free parking for employees. The Clinical Nurse IV, RN, position is for the 25-bed surgical unit. This ... a community hospital which is an extension of UNC Medical Center focusing on many of our elective surgical...well-being of the unique communities we serve. Summary: The Clinical Nurse IV practices at the level… more
- Fresenius Medical Center (Garner, NC)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Garner, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …(UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting ... or change at any time, with or without notice. Primary Responsibilities + Independently review and analyze pre and post service medical necessity, benefit, and… more
- Justice, Bureau of Prisons/Federal Prison System (Butner, NC)
- …Level 3 Facility, or Federal Correctional Complexe (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities through data ... of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and clinical practice… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Medical and Case Management services for Workers' Compensation. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, ... and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager.... review , continued stay reviews, and based on clinical judgment and state WCB Medical Treatment… more
- UNC Health Care (Raleigh, NC)
- … nursing care consistent with professional standards. Reporting and accountable to the Nurse Manager/Director, the Clinical Nurse is responsible for ... date: September 2025 - March 2026, the New Graduate Nurse Program will offer varied start dates based on...and confidence in the professional role. In addition to clinical orientation on the unit, the Residency program provides… more
- PruittHealth (Durham, NC)
- ** CLINICAL COMPETENCY COORDINATOR / NURSE EDUCATOR.** **Join the PruittHealth family, where the health and safety of our workforce is our top priority!** We're ... reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff,… more
- Dispatch Health (Raleigh, NC)
- …information. Championinformation, containedinDeck. + In collaboration with Market Manager and Medical Director, conduct monthly clinical meetingswith all staff. ... APP coaching and service recovery, as necessary. + Chart Review with aim to promote evidence based medical... practice and adherence toDispatchHealthclinicalpathways + Workaspart of a clinical care team with a DHMT ( Medical … more
- Sunrise Senior Living (Raleigh, NC)
- …NAME** Sunrise of Raleigh **Job ID** 2025-234120 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents ... administration, communication with resident support services and families, and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- CVS Health (Raleigh, NC)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- BAYADA Home Health Care (Raleigh, NC)
- …is seeking a Registered Nurse (RN) to fill the position of **RN Clinical Manager** for our Raleigh, NC Medicare Certified Senior Living home health office. This ... clients living in Senior Living Communities. **As an RN Nurse Manager your day may look like this!** +...and support business growth. + Management and mentoring of Clinical Associates and field staff + Facilitate new hire… more
- Elevance Health (Raleigh, NC)
- …Supports legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. + Acts as a resource for both ... ** Nurse Appeals - Litigation & Legal Support** **Location:**...clinical and non- clinical teams, by managing and...accurate entry, investigation, and analysis of state appeals; summarizing medical information for review by medical… more
- CenterWell (Lillington, NC)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... on-site at our Lillington, NC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- UNC Health Care (Hillsborough, NC)
- …The Hillsborough Hospital is located at 460 Waterstone Drive, Hillsborough, NC. The Clinical Support Technician II assigned to the 15-bed Emergency Department at the ... transport to the Main ED / Trauma Level 1 Medical Center in Chapel Hill. This diverse environment in...community hospital setting contributes to a challenging and rewarding clinical environment for all members of the multi-disciplinary healthcare… more
- UNC Health Care (Hillsborough, NC)
- …more about the program here: https://jobs.unchealthcare.org/pages/unc-hospitals-unc-rex-nursing-support-incentive-program_ Clinical Support Technician II needed for ... CCU is an 18 bed unit that provides comprehensive medical and surgical care to the most medically fragile...well-being of the unique communities we serve. Summary: The Clinical Support Technician II is responsible for assisting the… more
- UNC Health Care (Chapel Hill, NC)
- …no Holidays, and no on-call. Surgical Center at UNC Chapel Hill is looking for Clinical Support Tech II candidates with a team building and positive attitude. As a ... the health and well-being of the unique communities we serve. Summary: The Clinical Support Technician II is responsible for assisting the professional caregiver in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Primary Responsibilities + Through governance and performance monitoring, oversees all Clinical Services (CS) functions (prior authorization, concurrent review , ... and Utilization Review (UR) Programs. + Collaborates with the Chief Medical Officer on evaluation of departmental policies and procedures to ensure continuous… more