- CVS Health (Raleigh, NC)
- …Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate ... of Care: * Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and… more
- CVS Health (Raleigh, NC)
- …Interviewing and good technological skills + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations ... standard business hours. No weekends and no holidays.** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical… more
- Highmark Health (Raleigh, NC)
- …Nursing **EXPERIENCE** **Required** + 7 years of any combination of clinical , case management and/or disease/condition management experience, provider operations ... panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of...interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are… more
- Maxim Healthcare (Raleigh, NC)
- Maxim Healthcare in Raleigh is hiring for a Case Manager to oversee the clinical care of homecare clients Why This Role? + Balanced Responsibilities + ... + Recognition Programs + Expense Reimbursement Key Responsibilities: + Oversee the clinical care of homecare clients from admission through discharge + Manage care… more
- CVS Health (Raleigh, NC)
- …we do it all with heart, each and every day. **Job Summary** The Care Manager -Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible ... for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH)… more
- Elevance Health (Durham, NC)
- …Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee ... impact:** + Determines the medical necessity of requests using clinical criteria. + Performs physician-level case review...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- COOLSOFT (Raleigh, NC)
- …and content lead in collaboration with the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in ... related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL)...completing the business process documents, Business use cases, Business case scenarios, user acceptance test case scenarios,… more
- Veterans Affairs, Veterans Health Administration (Garner, NC)
- …dedicating appropriate time each week (one to three hours per care manager ) for case discussion, panel review/monitoring, and recommendations for collaborative ... psychiatrist position is administratively assigned to the Mental & Behavioral Health Service Line. PCMHI is a component of...matching the intensity of services with the level of clinical need Refers Veterans with severe/complex needs to an… more
- UNC Health Care (Chapel Hill, NC)
- …days and the player patient leaves us with a plan of care and a nurse case manager to connect them to services within their home geography. **Program Hours:** ... Brain and Body Program at UNC provides a comprehensive physical and behavioral health assessment to athletes recently retired from their professional football… more
- UNC Health Care (Chapel Hill, NC)
- …days and the player patient leaves us with a plan of care and a nurse case manager to connect them to services within their home geography. **Program Hours:** ... Brain and Body Program at UNC provides a comprehensive physical and behavioral health assessment to athletes recently retired from their professional football… more
- CenterWell (Raleigh, NC)
- …Intelligence Lead and support ad hoc reporting. * Develop basic modeling and business case analysis; work closely with Finance and Data teams * Coordinate with ACO ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time… more
- Highmark Health (Raleigh, NC)
- …Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and… more