- Humana (Raleigh, NC)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Raleigh, NC)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff.... management , and budget control. Departments involved are Utilization Management , Case Management , and… more
- Centene Corporation (Raleigh, NC)
- … team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… 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
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …Quality Management programs to include Survey Readiness, External Peer Review Program, and Quality Improvement. Works closely and collaboratively with other ... The Durham VA Health Care System is looking to fill one (1) Registered Nurse vacancy for the Sterile Processing Services (SPS) Department. The SPS Quality Registered… more
- KBR (Fayetteville, NC)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... a case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center or American … more
- KBR (Fort Bragg, NC)
- …compliance in meeting care goals. * Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center. + Demonstrated… more
- Actalent (Raleigh, NC)
- …education and adherence to established healthcare goals and care plans. + Review utilization information concerning patient care using clinical expertise and ... Actalent is Hiring a Remote Nurse Coach Job Description As a Nurse...care unit, med-surg, etc. + 2+ years of case management /triage/telehealth experience (telehealth Case Management experience is… 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 (Raleigh, 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
- Evolent (Raleigh, NC)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- CenterWell (Lillington, 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
- 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 ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- United Therapeutics (Raleigh, NC)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... on behalf of UTC + Attain a thorough understanding of site management tasks and responsibilities necessary to implement compliance with the protocol, applicable… 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