• Utilization Review Clinician

    Novant Health (NC)
    What We Offer Why This Role Matters As a Utilization Review Clinician , you will play a critical role in ensuring the integrity and compliance of patient ... most holidays required. + Serve as a leader resource in the Utilization Review process, for the behavioral health specialty area. + Coordinate and conduct… more
    Novant Health (12/24/25)
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  • Crisis Response Clinician

    City of Durham (Durham, NC)
    …service delivery documentation (including counseling/treatment planning), HIPAA/Confidentiality standards, utilization review , and data management. + Ability ... Crisis Response Clinician Print (https://www.governmentjobs.com/careers/durhamnc/jobs/newprint/5167824) Apply  Crisis Response Clinician Salary $66,703.00 -… more
    City of Durham (12/15/25)
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  • Payment Integrity Clinician

    Highmark Health (Raleigh, NC)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Georgia Medicaid Clinical Account Manager - Remote

    Prime Therapeutics (Raleigh, NC)
    …Medicaid Clinical Account Manager - Remote **Job Description** Innovative business clinician accountable for building and maintaining customer relationships as well ... fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for additional… more
    Prime Therapeutics (12/18/25)
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