- CVS Health (Raleigh, NC)
- …11:30am to 8:00pm EST with occasional holiday rotation. **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling… 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 ... to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine… 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
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. ... in a health-related field Preferred Certification(s) ANCC for Case Management ANCC for Mental Health ANCC for Primary Care...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- Humana (Raleigh, NC)
- …Occupational and Physical Therapy utilization review + Previous experience in utilization management , case management , discharge planning and/or home ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for...review depending on case findings. + Educates providers on utilization and medical management processes. + Enters… 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
- Elevance Health (Durham, NC)
- **Medical Management Nurse ** **Work schedule: M-F** **8:00am to 5:00pm EST. Will work 2-3 Saturdays per year** **Location:** This is a virtual position This role ... accommodation is granted as required by law._** The **Medical Management Nurse ** is responsible for review of...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- Fresenius Medical Center (Cary, NC)
- …direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- Humana (Raleigh, NC)
- …will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more