- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This position ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …+ Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity...+ Provides referrals to Case management, Disease Management, and Quality Department as needed. + Develop and review… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... treatment needs, and discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick ... patient care progression from acute care episode through post discharge for quality , efficiency, and effectiveness. The Utilization Manager works collaboratively… more
- Fresenius Medical Center (Cary, NC)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... this position participates in decision-making, teaching, leadership functions, and quality improvement activities that enhance patient care outcomes and facility… more
- Highmark Health (Raleigh, NC)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... in achieving their personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a timely manner. **ESSENTIAL… more
- Granville Health System (Oxford, NC)
- …and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members. ... excellence by looking for ways to improve and promote quality . Nursing Process - Assessment: Collects data in an...#Will ensure equipment for proper function and accuracy. Will review limits and alarms with RN. Emergency Situations:#Identifies an… more
- Fresenius Medical Center (Durham, NC)
- …As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility ... Manages the operations of the clinic, including costs, processes, staffing, and quality standards. + Provides leadership, coaching, and development plans for all… more
- Prime Therapeutics (Raleigh, NC)
- …+ Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary. + ... our passion and drives every decision we make. **Job Posting Title** Initial Review Pharmacy Technician **Job Description Summary** Plays a key role in medical and… more
- Marriott (Raleigh, NC)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... of responsibility that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates subsequent levels of… more
- UNC Health Care (Morrisville, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... payers, business leaders, and community partners to improve the quality and accessibility of care while lowering the cost...policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- UNC Health Care (Raleigh, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... Navigator will be to work with Asthma specialists to review and identify those who would potentially benefit from...overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity… more
- UNC Health Care (Chapel Hill, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity...policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- UNC Health Care (Chapel Hill, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity...policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… 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 ... clinicians to promote more effective performance and delivery of quality home care services, and is available at all...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- UNC Health Care (Chapel Hill, NC)
- …The Cardiac Electrophysiology and Advanced Heart Failure Clinic-Fayetteville Registered Nurse Coordinator is responsible for coordination and management of care ... for benchmarking purposes. Participates in performance improvement activities to promote quality patient care. Analyzes data for trends and makes suggestions for… more
- UNC Health Care (Morrisville, NC)
- …participating on a multidisciplinary team required. Experience in care management, utilization review , quality management preferred. **Knowledge/Skills/and ... payers, business leaders, and community partners to improve the quality and accessibility of care while lowering the cost...serve. **The ideal candidate would preferably be a Registered Nurse . While we would prefer a Registered Nurse… 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: 1. Incoming ... overall goal of the position is to enhance the quality of inter-hospital transfer management and satisfaction and to...* Must be licensed to practice as a registered nurse in the state of North Carolina **Professional Experience… more