- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment… 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
- CVS Health (Raleigh, NC)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... time, talking on the telephone, and typing on the computer. The UM Nurse Consultant utilizes clinical skills to coordinate, document and communicate all aspects of… more
- CVS Health (Raleigh, NC)
- …and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. +… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- UNC Health Care (Chapel Hill, 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
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- LifePoint Health (Hickory, NC)
- …execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and ... *Registered Nurse (RN), Clinical Case Manager* PRN * *...Commission, OSHA, CMS, HCFA, AHCA). * Mentors staff on Utilization Review (UR) standards and Length of… 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
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