- Humana (Raleigh, NC)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and ... licensed in a Compact State** The Utilization Management Behavioral Health Nurse completes...Qualifications** + Minimum of Associate Degree in Nursing + Registered Nurse ( RN ) licensure with… more
- Centene Corporation (Raleigh, NC)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- UNC Health Care (Chapel Hill, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... **Description** Have you ever considered a role in Care Management ? **UNC Medical Center in Chapel Hill is the...within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to… more
- UNC Health Care (Morrisville, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... the unique communities we serve. Summary: The Care Manager RN plays a crucial role in providing comprehensive and...within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to… more
- Elevance Health (Durham, NC)
- …state of North Carolina. The ** RN Case Manager** **(LTSS Service Coordinator- RN )** is responsible for overall management of member's case within the scope ... or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral … more
- Elevance Health (Durham, NC)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... active, unrestricted license, such as either a LCMHC, LCSW, RN (must have experience in behavioral health)...Bilingual communication skills in English and Spanish. + Previous utilization management experience highly desirable. + Experience… more
- Highmark Health (Raleigh, NC)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Elevance Health (Cary, NC)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... Preferred Skills, Capabilities, and Experiences: + Bilingual in Spanish. + Previous utilization management experience highly desirable. + Experience with taking… more
- Motion Recruitment Partners (Durham, NC)
- …Months **Required Skills & Experience** + Computer experience needed, documentation skills and communication + RN degree for 5-7 years + RN , RD or LCSW with 3 ... years of clinical and/or case management experience required. For some roles a Master's in...years of related experience may be considered. + For Behavioral Health specific roles, other applicable licensure may be… more