- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Datavant (Raleigh, NC)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials ...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- Cognizant (Raleigh, NC)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more