- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- CenterWell (Raleigh, NC)
- …Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual **Use your skills to make an impact** ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- CenterWell (Raleigh, NC)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- BAYADA Home Health Care (Roxboro, NC)
- **Join BAYADA as a Home Health Director - Roxboro, NC** Are you ready to lead with purpose in a dynamic and growing healthcare field? BAYADA Home Health ... experienced and compassionate **Director** to manage operations at our Roxboro, NC **Medicare-certified Home Health office** . The ideal candidate will have a… more
- CenterWell (Lillington, NC)
- …community and help us put health first** Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours ... by clinical personnel. This role is focused on both home health clinical quality assurance and ...clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the… more
- HCA Healthcare (Asheville, NC)
- … Services for your team of participants. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home ... Asheville, North Carolina, CarePartners provides compassionate post-acute care, including rehabilitation, home health , adult care, hospice and palliative care.… more
- HCA Healthcare (Asheville, NC)
- … Services for your team of participants. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home ... Asheville, North Carolina, CarePartners provides compassionate post-acute care, including rehabilitation, home health , adult care, hospice and palliative care.… more
- LifePoint Health (Rutherfordton, NC)
- …execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and ... staff in UR standards and LOS topics. Insures effective Utilization Review Process.1. Performs admission and concurrent...with the Social Worker.15. Initiates and facilitates referrals for home health care, hospice, medical equipment and… more
- LifePoint Health (Hickory, NC)
- …execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and ... Commission, OSHA, CMS, HCFA, AHCA). * Mentors staff on Utilization Review (UR) standards and Length of...in coordination with Social Workers. * Initiates referrals for home health , hospice, medical equipment, and facility… more
- UNC Health Care (Raleigh, NC)
- …Support** + Collaborate with outpatient or community-based partners (LTACH, SNFs, shelters, home health , FQHCs) + Ensure closed-loop handoffs with external care ... over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve....effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care… more