- Cognizant (Raleigh, NC)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Raleigh, NC)
- …/benefit management function. **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure ... all with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization Management is a… more
- Fresenius Medical Center (Garner, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- UNC Health Care (Raleigh, NC)
- …of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Evolent (Raleigh, NC)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- UNC Health Care (Chapel Hill, NC)
- … Nurse Practitioner, Physician Assistant, Clinical Pharmacist Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist) in the ... **Description** Have you considered a Neonatal Nurse Practitioner career with UNC Health? This opportunity...At all times care will be provided through independent utilization of approved protocols and procedures and under the… more
- CenterWell (Lillington, NC)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... on-site at our Lillington, NC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient...A minimum of 2 years of experience as a Registered Nurse (RN). + Previous experience in… more
- UNC Health Care (Chapel Hill, NC)
- …of professional nursing. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... of the unique communities we serve. Summary: The Transplant Nurse Coordinator (TNC) is responsible for coordinating the total...for both patient and graft survival. Reviews patient resource utilization with administrative and clinical staff to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Nursing, Maternity Nursing, Population health, Disease Management. + Current licensed Registered Nurse (RN) with compact state licensure; bachelor's degree ... services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager...HIPAA) for Case Management and self-insured clients. + Uses clinical tools for patient assessment, creating individualized care plans.… more
- CenterWell (Raleigh, NC)
- …Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with ... hours spanning Friday afternoon through Monday afternoon to support clinical operations across multiple branch locations.** The **Weekend Regional...A minimum of 2 years of experience as a Registered Nurse (RN). + Home health experience… more
- Deloitte (Raleigh, NC)
- …certification a plus (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM) + Experience as clinical registered nurse , physician, physician assistant, case manager, ... or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical ...clinical documentation specialist, utilization review, informatics RN, Quality, DRG Validation and health… more
- UNC Health Care (Chapel Hill, NC)
- …of professional nursing. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... (CQI)Participates in CQI efforts to optimize patient and graft outcomes. Reviews clinical practices and patient resource utilization to identify areas for… more
- UNC Health Care (Chapel Hill, NC)
- …Managers, Social Workers, and Care Management Assistants. + Candidate must be a ** Registered Nurse (RN)** or **Licensed Clinical Social Worker (LCSW/LCSWA)** ... Care Management Department team(s). Provides management direction to Case Managers, Utilization Managers, Clinical Social Workers, Clinical Authorization… more
- UNC Health Care (Chapel Hill, NC)
- …degree in Nursing **Licensure/Certification Requirements:** * Must be licensed to practice registered nurse in the state of North Carolina **Professional ... the integrating and functions of point of entry case management, utilization review, and effective patient flow activities. Responsibilities: 1. Capacity Planning-… more
- Highmark Health (Raleigh, NC)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- UNC Health Care (Chapel Hill, NC)
- …of professional nursing. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... maximizing the outcomes for both patient and graft survival. Reviews patient resource utilization with administrative and clinical staff to identify areas for… more
- UNC Health Care (Morrisville, NC)
- …major in nursing within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North ... self-management. 3. Risk Segmentation: a. Utilize standardized tools and clinical judgment to identify and assess the risk level...* Minimum of 2 years of experience as a registered nurse . **Knowledge/Skills/and Abilities Requirements:** * *… more
- UNC Health Care (Chapel Hill, NC)
- …major in nursing within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North ... self-management. 3. Risk Segmentation: a. Utilize standardized tools and clinical judgment to identify and assess the risk level...* Minimum of 2 years of experience as a registered nurse . **Knowledge/Skills/and Abilities Requirements:** * *… more