- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- CaroMont Health (Gastonia, NC)
- Job Summary: The Pre-Authorization Specialist is a member of the Utilization Review Department who is responsible for verifying eligibility, obtaining ... authorizations for care, via phone, fax, or payer websites. The Pre-Authorization Specialist provides detailed and timely communication to both payers and clinical… more
- ManpowerGroup (Durham, NC)
- Our client, is seeking a Utilization Management Specialist to join their team. Job Title: Utilization Management Specialist Location: Remote Pay Range: ... jobs. Outbound calls only to members and providers to review medication request. Calls/Case Metrics are 6 to 8...or members to obtain the medical information for the review . * Identifies and refers organization determinations that require… more
- Novant Health (Winston Salem, NC)
- Job Summary NOVANT CORPORATE PHARMACY PHARMACY BENEFITS SPECIALIST Novant Health is an integrated system of physician practices, hospitals, outpatient centers, and ... the way on their journey to health and wellness. The Pharmacy Benefits Specialist at Novant Health works closely with the Pharmacy Benefits Manager (PBM), Benefits… more
- Novant Health (Winston Salem, NC)
- Job Summary ACUTE CARE Clinical Pharmacist Specialist Infectious Disease Novant Health is seeking a Clinical Pharmacist Specialist Infectious Disease, to join ... wellness. Essential functions include: + Facilitates pharmaceutical care services, medication utilization systems within assigned services and care areas to ensure… more
- UNC Health Care (Goldsboro, NC)
- …matters/scheduled accounts that require attention to Pre-Arrival Team Lead/Manager. 7. Notify Utilization Review & Case Management regarding any admissions that ... unique communities we serve. Summary: The Pre- Arrival Authorization Specialist I will serve patients/customers and physician offices by...need Clinical Review . 8. Review /Sign/Commit to the Patient Access… more
- Air National Guard Units (Kelly, NC)
- …The purpose of this position is to serve as a customer support specialist performing work involving analytical and evaluative duties related to classified and ... one of 9 states with NO state income tax. Responsibilities As a IT SPECIALIST (CUSTOMER SUPPORT) (Title 32) with the Texas National Guard, your duties will include,… more
- Joint Activities (North Liberty, NC)
- …positions in the competitive service. About the Position: Serves as an IT Specialist (Network Services) for the Joint Activities located at Fort Liberty, North ... analytical work pertaining to planning, development, installation, programming, testing, utilization and/or modification of the command's secure and non-secure… more
- Truist (Winston Salem, NC)
- …English (Required) **Work Shift:** 1st shift (United States of America) **Please review the following job description:** Key contributor to the Truist second ... reporting cadence, data lineage mapping and controls, socialization plan, and leadership review and approvals required. 6. Develop and deliver strategic data risk… 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 ... Transfer Requests- Continually monitor work list(s) to appropriately triage patient transfer requests. Conduct and document assessment of proposed transfers and facilitate provider and caregiver consultations to develop a transfer plan per departmental… more
- US Foods (Zebulon, NC)
- …through the following: consultative services to aid customers through improved utilization of the category; sales force training; conducting product demonstrations ... disability, employee stock purchase plan, and life insurance. To review available benefits, please click here: https://www.usfoods.com/careers/benefits.html **Related Experience:**… more
- Granville Medical Center (Oxford, NC)
- …Assists Providers: Psychosocial Assessments; Discharge planning; Treatment plan development and review . 9. Monitors compliance with standards of care for patients ... arrangements for case management patients. 16. Provides input into resource utilization and appropriate care settings. 17. Maintains positive working relations with… more
- Service Source (Fayetteville, NC)
- …These duties and responsibilities will be rated on the Annual Performance Review . + Conduct engaging, relevant, informative, and dynamic group sessions with high ... reports, case notes, and other supporting documentation, meeting milestone utilization expectations. Additional Responsibilities + Be aware of and respond… more
- HCA Healthcare (Asheville, NC)
- …is responsible for the safe, effective, evidence-based, and cost-effective selection and utilization of medications for the patients in which they serve. The ... you to apply for our Advanced Clinical Pharmacist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews.… more
- Granville Health System (Oxford, NC)
- …Assists Providers: Psychosocial Assessments; Discharge planning; Treatment plan development and review . 9. Monitors compliance with standards of care for patients ... arrangements for case management patients. 16. Provides input into resource utilization and appropriate care settings. 17. Maintains positive working relations with… more
- Highmark Health (Raleigh, NC)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- City of Durham (Durham, NC)
- …service delivery documentation (including counseling/treatment planning), HIPAA/Confidentiality standards, utilization review , and data management. + Ability ... teams-consisting of a Crisis Response Clinician, a Peer Support Specialist , and EMT-to 911 calls for service involving behavioral...of a Crisis Response Clinician and a Peer Support Specialist -to follow-up with residents within 48 hours of initial… more
- Verint Systems, Inc. (Raleigh, NC)
- …enrollment processes, including obtaining and analyzing benchmark data and utilization data, identifying trends, preparing recommendations with impact assessments ... across plans to address issues, discuss trends & best practice, utilization and opportunities for improvement. + Responsible for ensuring internal compliance… more
- KBR (Jacksonville, NC)
- …the development and utilization of required databases. + Conduct peer (record) review s for the HP Staff as directed by governing credentialing body and local ... by local HP program manager and/or coordinator. + Document work performed, utilization , encounters, referrals, and all other information in the Military's… more
- Lowe's (Charlotte, NC)
- …in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical position + ... will be responsible for medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside. **What you will do** + Manage… more