- Centene Corporation (Raleigh, NC)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... WORK 10 HOURS.** **THIS ROLE WILL MAINLY SUPPORT MEDICARE BEHAVIORAL HEALTH ALL STATES AND DELAWARE MEDICAID...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... text outlines the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate use of hospital… more
- Elevance Health (Durham, NC)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- Summary The Inpatient Behavioral Clinic is looking for Behavioral Health (RN) to join our Team. RN will directly reports to the Nurse Manager or designee of ... the Inpatient Behavioral Health Unit. He/She demonstrates competency in...a risk to staff and Veterans. Demonstrates competency in utilization of Prevention and Management of Disruptive Behavior (PMDB).… more
- LifePoint Health (Sylva, NC)
- …a comprehensive first evaluation for patients in the involuntary commitment process. Behavioral Health responsibilities in this role may include: group therapy; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- Granville Health System (Oxford, NC)
- …Care case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- Elevance Health (Winston Salem, NC)
- ** Behavioral Health Care Manager I (3rd Shift -After Hours)** This role enables associates to work virtually full-time, with the exception of required in-person ... on holidays as part of a rotating schedule._ The ** Behavioral Health Care Manager I (3rd Shift...or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review .… more
- Humana (Raleigh, NC)
- …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... part of our caring community and help us put health first** The Behavioral Health ...insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review… more
- Granville Medical Center (Oxford, NC)
- …Care case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- CenterWell (Raleigh, NC)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more