• SNF Utilization Management RN…

    Humana (Raleigh, NC)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (09/12/25)
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  • RN , Manager, Utilization Management…

    Humana (Raleigh, NC)
    …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review ....business administration. **Additional Information** + **Workstyle:** This is a remote position. + **Travel:** Up to 25% travel may… more
    Humana (09/28/25)
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  • Utilization Review Clinician…

    Centene Corporation (Raleigh, NC)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
    Centene Corporation (09/27/25)
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  • RN Clinical Manager, Home Health

    CenterWell (Washington, NC)
    …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...A minimum of 2 years of experience as a Registered Nurse ( RN ). + Home… more
    CenterWell (09/28/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Raleigh, NC)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
    Prime Therapeutics (09/04/25)
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  • Disease Management Nurse - Remote

    Sharecare (Raleigh, NC)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (09/13/25)
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  • Clinical Reviewer, Nurse - Cardiology

    Evolent (Raleigh, NC)
    …**Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + Associate or Bachelors in Nursing (Must ... , you will be a key member of the utilization management team. We can offer you a meaningful way...be a Registered Nurse ) - **Required** + You must be… more
    Evolent (09/28/25)
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  • Medical Records Technician (CDIS)…

    Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
    …severity of illness, risk of mortality, complexity of care, and utilization of resources. Identifies opportunities for documentation improvement by ensuring that ... of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving...Not authorized Virtual: This is not a virtual position Remote : This is not a remote position… more
    Veterans Affairs, Veterans Health Administration (09/19/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Raleigh, NC)
    …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year ... **Required** + None **Preferred** + PA clinical licensure/certifications such as RN , RD, Pharmacist **Language (Other than English):** None **Travel Requirement:**… more
    Highmark Health (08/26/25)
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