- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …member's benefit coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based ... and CMS criteria sets * Experience with both inpatient and outpatient reviews for Behavioral Health (examples: TMS, ECT, ABA, Psychotherapy, IOP, PHP, IP Stays,… more
- Brighton Health Plan Solutions, LLC (NC)
- …criteria sets * Experience with both inpatient and outpatient reviews including Behavioral Health , DME, Genetic Testing, Clinical Trials, Oncology, and/or ... Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in...URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. * 3+ years'… more
- Highmark Health (Raleigh, NC)
- …panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of ... various resources to assist members in achieving their personal health goals. Will work with providers to insure quality...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more