- Cognizant (Raleigh, NC)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan +… more
- Humana (Raleigh, NC)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Battelle Memorial Institute (Fort Bragg, NC)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- CenterWell (Youngsville, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... **Branch Location** : Youngsville, NC **This is not a remote or work-from-home position. This position requires you to...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- CenterWell (Raleigh, NC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… more
- Oracle (Raleigh, NC)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter...offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report… more
- Battelle Memorial Institute (Fort Bragg, NC)
- …+ Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health ... program policy + Coordinate attendance and agenda at Case Review Committee with military and civilian agencies + Coordinate...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more