- Humana (Raleigh, NC)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Humana (Raleigh, NC)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- HCA Healthcare (Asheville, NC)
- …pharmacy supervisor will work directly with the certified pharmacy technician to review home medication lists to provide a streamlined medication reconciliation ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more
- UNC Health Care (Rocky Mount, NC)
- …and cost-efficient care of patients through such case management functions as utilization review and discharge planning. May facilitate the execution of ... reviews for private insurance companies, Medicare and Medicaid, in accordance with utilization review guidelines. Tactfully and effectively informs Manager of… more
- UNC Health Care (Chapel Hill, NC)
- …admissions and transfer processes of patients to Advanced Care at Home through comprehensive assessment, planning and coordination. The PAO balances Advanced ... Care at Home and rapid response capacity with incoming admissions and...facilities to ensure appropriate patient selection. Make referrals to Utilization Management nurses and Physician Advisors on level of… more
- Evolent (Raleigh, NC)
- …role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to ... cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process improvement and… more
- AmeriHealth Caritas (Asheville, NC)
- …any identified non-health related unmet needs.; + Provides and supports utilization management to gather and provide additional information to ensure timelines ... and member needs are met. ; + Review medication list and educate Members with pharmacy needs,...electronic care management platforms where applicable. + Monitor appropriate utilization and coordinate services with other payer sources, make… more
- Humana (Raleigh, NC)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance organizations,… more
- Humana (Raleigh, NC)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance organizations,… more
- HCA Healthcare (Asheville, NC)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity… more