- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This position ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- 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 ... Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity...+ Provides referrals to Case management, Disease Management, and Quality Department as needed. + Develop and review… more
- CVS Health (Raleigh, NC)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and… more
- CVS Health (Raleigh, NC)
- …a keyboard and speaking to customers. Preferred Qualifications: - 1+ years' experience Utilization Review experience -1+ years' experience Managed Care - Strong ... deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and… more
- 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 ... Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs...to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. * Develop and review… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick ... patient care progression from acute care episode through post discharge for quality , efficiency, and effectiveness. The Utilization Manager works collaboratively… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …identification and integration of evidence-based practice/research with clinical expertise to improve quality of care and resource utilization at the expert ... Care System is seeking a dedicated Registered Home Health Nurse to join the Social Work team. Responsibilities The...for the caregiver. The CHN should have strong clinical review skills with the ability to review … more
- PruittHealth (Raleigh, NC)
- …and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and ... **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the...clinical operation outcomes to determine priority needs/opportunities. She/he recommends utilization of resources in an efficient and economical manner… more
- Fresenius Medical Center (Cary, NC)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... this position participates in decision-making, teaching, leadership functions, and quality improvement activities that enhance patient care outcomes and facility… more
- Granville Health System (Oxford, NC)
- …and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members. ... excellence by looking for ways to improve and promote quality . Nursing Process - Assessment: Collects data in an...#Will ensure equipment for proper function and accuracy. Will review limits and alarms with RN. Emergency Situations:#Identifies an… more
- Fresenius Medical Center (Rolesville, NC)
- …As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility ... Manages the operations of the clinic, including costs, processes, staffing, and quality standards. + Provides leadership, coaching, and development plans for all… 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 ... the unique communities we serve. Are you a Registered Nurse looking to make a fun transition with skill...overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity… more
- UNC Health Care (Morrisville, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... payers, business leaders, and community partners to improve the quality and accessibility of care while lowering the cost...policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- UNC Health Care (Chapel Hill, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity...policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- CenterWell (Raleigh, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... clinicians to promote more effective performance and delivery of quality home care services, and is available at all...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- UNC Health Care (Chapel Hill, NC)
- …The Cardiac Electrophysiology and Advanced Heart Failure Clinic-Fayetteville Registered Nurse Coordinator is responsible for coordination and management of care ... with at least two years of experience in Cardiology, Care coordination, and/or quality improvement. Schedule expectations: Standard work hours - 40 a week _This… more
- UNC Health Care (Raleigh, NC)
- …through the integrating and functions of point of entry case management, utilization review , and effective patient flow activities. Responsibilities: 1. Incoming ... overall goal of the position is to enhance the quality of inter-hospital transfer management and satisfaction and to...* Must be licensed to practice as a registered nurse in the state of North Carolina **Professional Experience… more