- Evolent (Raleigh, NC)
- …experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies… more
- Veterans Affairs, Veterans Health Administration (Salisbury, NC)
- …with advanced PACs and voice recognition systems. Establish imaging protocols. Review imaging requests, including utilization management ensuring appropriate ... in quality control /quality management including department and hospital level peer review activities. Teaching house staff and medical students assigned to Imaging… more
- Elevance Health (Asheville, NC)
- …child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless ... to the same basic benefits and services, including Physical health , Behavioral health , Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD) services,… more
- CVS Health (Troy, NC)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... culture of continuous improvement, with the goal of changing health care for the better. **Position Summary:** At CVS...an essential pharmacist function + Ability to work in home store, and across the market in other locations,… more
- CVS Health (Raleigh, NC)
- …experience in Health Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current ... At CVS Health , we're building a world of health...care resources. This is a remote based (work from home ) role. Preferred candidates will have Internal Medicine or… more
- Defense Health Agency (North Liberty, NC)
- …population as required. + Participate in quality assurance, and quality improvement studies, utilization review , risk management, and peer review activities. ... WOMACK Army Medical Center in the Department of Behavioral Health at the Womack Army Medical Center, Fort Bragg,...medical center and GME facility serving Fort Liberty, the home of Airborne and Special Operations and the largest… more
- Humana (Raleigh, NC)
- …quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization,… more
- CenterWell (Raleigh, NC)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... part of our caring community and help us put health first** The Lead - Medicaid Customer Success oversees...performance and proactively bring issues to the forefront for review + Support new business implementations with a goal… more
- Humana (Raleigh, NC)
- …quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization,… more
- Evolent (Raleigh, NC)
- **Your Future Evolves Here** Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit ... growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great...Nurse, you will be a key member of the utilization management team. We can offer you a meaningful… more