- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience preferred. + Minimum 1 year clinical… more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. Summary: This position facilitates utilization management processes to support the right care is provided at the ... right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Cognizant (Raleigh, NC)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,… more
- CenterWell (Raleigh, NC)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- Humana (Raleigh, NC)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Winston Salem, NC)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location** : This role...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Workers' Compensation. The Workers' ... Compensation Nurse Case Reviewer collaborates with medical care providers, employers,...for timely return to work. + Provides case management, utilization review , continued stay reviews, and based… more
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… 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 ... Title: Special Operations Nurse Case Manager (USASOC DPA, Fort Bragg, NC)...and services. We are seeking a stellar Special Operations Nurse Case Manager that will provide a full range… more
- HCA Healthcare (Asheville, NC)
- …our Registered Nurse Home Care Coordinator CarePatners opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a ... individual is recognized. Submit your application for the opportunity below:Registered Nurse Home Care Coordinator with CarePartners. This position is eligible for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …(BHPS) provides Case Management services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager reports to the Manager of ... for Case Management. + Determines appropriate care level and resource utilization for complex cases. + Facilitates discharge planning and evaluates alternative… more
- ERP International (Camp Lejeune, NC)
- …providers for 90% of all referrals. + Provides timely, descriptive feedback regarding utilization review issues. + Reviews and enters first right of refusal ... and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues...the last two years as a practical or vocational nurse . Licensure:** Current, full, active and unrestricted license as… more
- Granville Medical Center (Oxford, NC)
- Registered Nurse - ICU Location: Granville Health System, Oxford, NC About Granville Health System: For over a century, Granville Health System has been at the ... and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members.… more
- Granville Health System (Oxford, NC)
- Registered Nurse # ICU Location: Granville Health System, Oxford, NC # About Granville Health System: For over a century, Granville Health System has been at the ... and accountability for a group of patients, providing care through the continued utilization of the nursing process in collaboration with other health team members.#… more
- Fresenius Medical Center (Fayetteville, NC)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Garner, 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 (Smithfield, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new...from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the meeting to… more
- UNC Health Care (Hendersonville, NC)
- …for behavioral health services. Working closely with behavioral health clinicians, utilization review , case management, and finance teams, the Intake ... appropriate care transition and patient placement. + Liaise with utilization review , psychiatry leadership, risk management, and/or...+ Must be licensed to practice as a Registered Nurse in the state of North Carolina or one… more
- CenterWell (Asheville, 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...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more