- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- CVS Health (Raleigh, NC)
- …more personal, convenient and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization management is a ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of… more
- Lincoln Financial Group (Raleigh, NC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... 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
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review ...management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization… more
- Motion Recruitment Partners (Durham, NC)
- Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health ... insurance vertical, has a contract opening for a Utilization Management Specialist. They have over 4...Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director.… more
- Robert Half Office Team (Durham, NC)
- …industry, located in Durham, North Carolina, and we're looking to bring a Utilization Management Specialist on board. This role involves making outbound calls ... Identify and refer organization determinations that require a clinical review to a nurse or Medical Director....Management System (CMS) and Facets * Knowledge of review processes * Ability to adhere to protocols and… more
- Fresenius Medical Center (Durham, NC)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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 ... discharge plan. Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per… more
- UNC Health Care (Chapel Hill, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... discharge plan. Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per… more
- CenterWell (Durham, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Management services to its clients. Care Coordinators facilitate care management and utilization review by performing data collection, data ... reviews. The Senior Care Coordinator reports to the Senior Nurse Manager, Utilization Management . Primary...but not required. + History working in medical records review , an MA or ancillary staff member preferred. About… more
- UNC Health Care (Chapel Hill, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Inpatient Care ... 7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely… more
- UNC Health Care (Chapel Hill, NC)
- …cost effectiveness through the integrating and functions of point of entry case management , utilization review , and effective patient flow activities. ... needs. The overall goal of the position is to enhance the quality of inter-hospital transfer management and satisfaction and to promote continuity of care and… more
- UNC Health Care (Raleigh, NC)
- …cost effectiveness through the integrating and functions of point of entry case management , utilization review , and effective patient flow activities. ... 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
- CVS Health (Raleigh, NC)
- …(typically every 4-6 weeks)** The Health Coach Consultant: Chronic Condition Nurse utilizes a collaborative process of assessment, planning, implementation, and ... You will assess members through the use of clinical tools and information/data review to conduct comprehensive evaluation of needs and benefit plan eligibility for… more