- Justice, Bureau of Prisons/Federal Prison System (Butner, NC)
- …Medical Care Level 3 Facility, or Federal Correctional Complexe (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Brighton Health Plan Solutions, LLC (NC)
- …Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more
- Cognizant (Raleigh, NC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …VA Health Care System is looking to fill one (1) full-time Registered Nurse vacancy for the Health Administration Service. Responsibilities Job Description/ Scope of ... Practice: The Registered Nurse for Clinical Documentation Improvement (CDI) has a specific practice setting in Health Administration Service. The practice of the… more
- Elevance Health (Durham, NC)
- …4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... is granted as required by law. The **Medical Management Nurse ** is responsible for review of the...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer skills. Please… more
- CVS Health (Raleigh, NC)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- HCA Healthcare (Asheville, NC)
- …opportunity compelling, we encourage you to apply for our Home Care Registered Nurse Coordinator PACE opening. We promptly review all applications. Highly ... each individual is recognized. Submit your application for our Home Care Registered Nurse Coordinator PACE (Program of All Inclusive Care for the Elderly) opening… more
- HCA Healthcare (Highlands, NC)
- …important to you, we encourage you to apply for our Case Management Registered Nurse opening. Our team will promptly review your application. Highly qualified ... colleagues in their positions. Join our Team as a(an) Case Management Registered Nurse and access programs to assist with every stage of your career. **Benefits**… more
- Lincoln Financial (Raleigh, NC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more