- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... coverage while working remotely. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced… 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)
- …position responsibilities that demonstrates leadership, experience, and creative approaches to management of complex patient care. The Nurse III registered ... level that is sustainable, experience, and creative approaches to management of complex situations. Roles may include, but are...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … 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
- Humana (Raleigh, NC)
- …working with CMS Guidelines, MCG and/or InterQual guidelines. + 2+ years of Utilization Management (UM), Pre-Auth, and/or other managed care review experience. + ... their best health. Humana CarePlus is seeking a Pre-Authorization Nurse who reviews prior authorization requests for...for review depending on case findings. Educates providers on utilization and medical management processes. + Enters… 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