- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Raleigh, NC)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Raleigh, NC)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Elevance Health (Durham, NC)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... shift between 8 AM and 6 PM Eastern. The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… 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)
- …practice is defined in the four (4) dimensions outlined in the Nurse Qualification Standards. PRACTICE (Ethics, Resource Utilization ) ETHICS: Provides leadership ... Care System is looking to fill one (1) full-time Chief Registered Nurse vacancy for Surgery. Responsibilities Job Description/Scope of Practice The Associate Chief… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Care System is looking to fill one (1) full time Registered Nurse vacancy for the Referral Coordinator Team. Responsibilities Job Description/Scope of Practice ... BSN with a Master's in a health-related field Preferred Certification(s) ANCC for Case Management ANCC for Mental Health ANCC for Primary Care ANCC for Med Surg VA… more
- CVS Health (Raleigh, NC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Elevance Health (Durham, NC)
- ** Nurse Reviewer I** A proud member of the...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Actalent (Cary, NC)
- …+ Triage skills + Acute care + Oncology nursing + RN license + Utilization management + Patient education Additional Skills & Qualifications + Registered ... Job Title: Telehealth NurseJob Description As a Telehealth Nurse , you will counsel and educate new and...Nurse with current unrestricted multi-state compact state license (NC)… more
- Fresenius Medical Center (Garner, NC)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Knightdale, NC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Sharecare (Raleigh, NC)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- UNC Health Care (Garner, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... plans are evidence-based, culturally sensitive, and promote patient engagement and self- management . 3. Risk Segmentation: a. Utilize standardized tools and clinical… 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: ... position is to enhance the quality of inter-hospital transfer management and satisfaction and to promote continuity of care...* Must be licensed to practice as a registered nurse in the state of North Carolina Professional Experience… more
- Gentiva (Cary, NC)
- …budgeting while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain strong relationships ... team. This role is ideal for a licensed Registered Nurse (RN) with strong leadership experience in hospice care,...experience in hospice care, home health, or clinical operations management . If you're a natural leader who is passionate… more
- AbbVie (Raleigh, NC)
- …recruitment, investigator meetings, external expert identification, and external collaboration management . + Serve as internal medical and scientific resource to ... core capabilities in strategic segmentation, as well as optimal resource utilization . + Responsible for compliance with applicable Corporate and Divisional Policies… more