• Utilization Review Specialist

    CaroMont Health (Gastonia, NC)
    …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... retrospective clinical reviews/appeals as part of denial process. The UR Specialist will be cross trained to...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… more
    CaroMont Health (10/11/25)
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  • Utilization Review Denials Nurse

    UNC Health Care (Kinston, NC)
    …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
    UNC Health Care (11/20/25)
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  • Denials Prevention Specialist , Clinician…

    Datavant (Raleigh, NC)
    …The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity ... letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +...experience + 2 years Health Plan or Acute Care UR /CM + Preferred Experience: 5 years acute care or… more
    Datavant (11/12/25)
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