- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- UNC Health Care (Hendersonville, NC)
- …of care and cost effectiveness through the integrating and functions of care management , utilization review and discharge planning. The Care Manager ... based on approved criteria and standards per the Hospital Utilization Review Plan. Directs delivery of notifications...Required * Must be licensed to practice as a Registered Nurse in the state of North… 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 ... of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional… more
- LifePoint Health (Hickory, NC)
- * Registered Nurse ( RN ), Clinical...care management as prescribed in the initial Utilization Review Plan with regard to resources, ... as an employee, but as a person. As a * registered nurse ( RN )* joining our...(GLOS) for each patient. Reports to: Director of Case Management ESSENTIAL FUNCTIONS . Assists with developing specific departmental… more
- LifePoint Health (Henderson, NC)
- …or local law. **Job:** **Case Management /Social Services* **Organization:** ** **Title:** * Registered Nurse ( RN ) Case Manager Full Time* **Location:** ... Registered Nurse ( RN ) Case...skills. Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by… more
- CVS Health (Raleigh, NC)
- …affordable. **Position Summary:** This is a full-time telehealth role for a Registered Nurse with **Virtual Group Coaching and Telehealth experience required.** ... regulatory and accreditation guidelines **Required Qualifications** - Must be an Registered Nurse with **Virtual Group Coaching Presentation** experience for… more
- Fresenius Medical Center (Gastonia, 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 (Matthews, 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
- Novant Health (Mint Hill, NC)
- …day supervision, operations, monitoring ongoing quality, productivity, and efficiency for both Utilization Review and Case Management activities. Is ... (CCM), preferred. + Additional Skills (required): Current practice in case management / utilization review ; regulatory/governing standards, policies, and… more
- Highmark Health (Raleigh, NC)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… 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...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: * Uses approved criteria and conducts ... referrals. Initiates appropriate social work referrals. * Performs utilization management assessments and interventions, using collaboration...Required * Must be licensed to practice as a Registered Nurse in the state of North… more
- UNC Health Care (Chapel Hill, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Highmark Health (Raleigh, NC)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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...Requirements:** * Must be licensed to practice as a registered nurse in the state of North… more
- 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 ... cases preferred. Essential Qualifications * Current licensed LPN or Registered Nurse ( RN ) with state...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 ... **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current...in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of… more
- CVS Health (High Point, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... Suite (PowerPoint, Word, Excel, Outlook) **Preferred Qualifications** - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care -… more