- 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 ... as needed, most holidays required. + Serve as a leader resource in the Utilization Review process for Behavioral Health acute care . + Coordinate and conduct… more
- City of Durham (Durham, NC)
- …service delivery documentation (including counseling/treatment planning), HIPAA/Confidentiality standards, utilization review , and data management. + Ability ... health, substance use, and conflict mediation needs. The Crisis Response Clinician is responsible for behavioral health assessments, therapeutic interventions,… more
- 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