- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Raleigh, NC)
- …care more personal, convenient and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...**Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current… more
- Sharecare (Raleigh, NC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...the disease management program intervention guidelines. An RN is supervised by an Operations Manager (OM). All… more
- Veterans Affairs, Veterans Health Administration (Charlotte, NC)
- Summary The Registered Nurse (Outpatient Mental Health) is responsible and accountable for all elements of the nursing process when providing and/or supervising ... , and customer satisfaction throughout the continuum of care. Responsibilities The Registered Nurse (Outpatient Mental Health) is responsible for providing… more
- Highmark Health (Raleigh, NC)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- CenterWell (Salisbury, NC)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... **Branch Location** : Salisbury, NC **This is not a remote or work-from-home position. This position requires you to...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Guardian Life (Raleigh, NC)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Highmark Health (Raleigh, NC)
- … - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** +… more
- United Therapeutics (Raleigh, NC)
- …Degree preferably in a health, biological sciences, or related field or + Registered Nurse ( RN ) nursing qualifications or relevant clinical research ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Lowe's (Charlotte, NC)
- …+ CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse + CDMS - Certified Disability Management Specialist + COHN - Certified ... 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation +...Clinical experience + 3-5 Years of Experience required with Nurse Case Management Software, along with Microsoft… more
- Elevance Health (NC)
- **Be Part of an Extraordinary Team** ** Nurse Medical Management I** **Location:** Remote - Candidates must reside within 50 miles or 1-hour commute each way ... experience. **Preferred skills, qualifications and experiences:** + Prior experience in inpatient Utilization Management , preferred. + 3-5 years of experience in… more
- BlueCross BlueShield of North Carolina (NC)
- …(Hiring Requirements)** + RN with 3 years of clinical and/or case management experience required + Additional direct experience in case management with ... of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive...roles, you can choose where to work - fully remote in one of the states listed below, in… more