- Lincoln Financial Group (Raleigh, NC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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 ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Elevance Health (Cary, NC)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Prime Therapeutics (Raleigh, NC)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Fresenius Medical Center (Rolesville, 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
- Sedgwick (Raleigh, NC)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… 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
- 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
- UNC Health Care (Chapel Hill, 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
- CenterWell (Raleigh, 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
- Highmark Health (Raleigh, NC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions provides Utilization Review / Case Management / Medical Management /Claims Review services to its clients. ... Care Coordinators facilitate care management and utilization review by...data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regards to… more
- United Therapeutics (Durham, NC)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... Lung Disease (PH-ILD) through use of approved materials + Review with patients the process steps for starting therapy...to UT products and disease states, as directed by management to maintain high level competency + Coordinate and… 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