- 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
- Cognizant (Raleigh, NC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Raleigh, NC)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Manager, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the...Qualifications + Active and unrestricted license as a Registered Nurse (RN) + Bachelor's degree in nursing, (or equivalent… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …The Durham VA Health System, has 1 vacancy for a part-time Registered Nurse , working in the Surgical Intensive Care Unit (SICU). Responsibilities Job Description/ ... analgesic sedation and paralytic drug administration. The unit is staffed with a nurse patient ratio of 1:1 to 1:3 depending upon patient acuity levels/needs.… 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)
- **Medical Management Nurse ** **Hours: Candidates will work 8a-5pm PST with 1 weekend per year-open for weekend work holidays voluntary** **Location** : This role ... accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... and Grievance Nurse is responsible for conducting daily clinical and benefit...accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and… more
- Elevance Health (Durham, NC)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Elevance Health (Durham, NC)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Highmark Health (Raleigh, NC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Raleigh, NC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… 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
- CVS Health (Raleigh, NC)
- …and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits ... and/or member's needs to enable appropriate utilization of services and/or administration and integration with available...per account needs - 3+ years as a Registered Nurse performing chronic condition assessments and education in a… 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
- UNC Health Care (Raleigh, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager must be ... discharge plan. Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per… more
- Highmark Health (Raleigh, NC)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more