- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced… more
- Elevance Health (Durham, NC)
- …as required by law._** The **Medical Management Nurse ** is responsible for review of the most complex or challenging cases that require nursing judgment, ... and/or Provider on select cases, such as cases the nurse deems particularly complex , concerning, or unclear....experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- UNC Health Care (Raleigh, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the meeting to...patient needs and concerns through scheduled touch points and review of documentation . Escalate urgent or complex… more
- Humana (Raleigh, NC)
- …enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million ... The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team to… more