• Utilization Review Nurse

    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
    UNC Health Care (09/04/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Raleigh, NC)
    …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
    Lincoln Financial (10/01/25)
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  • Utilization Review Clinician…

    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
    Centene Corporation (10/04/25)
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  • SNF Utilization Management RN - Compact Rqd

    Humana (Raleigh, NC)
    …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
    Humana (09/12/25)
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  • RN, Manager, Utilization Management Nursing

    Humana (Raleigh, NC)
    … Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) years ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing… more
    Humana (09/28/25)
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  • Case Manager, Registered Nurse

    CVS Health (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
    CVS Health (10/02/25)
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  • Clinical Appeal and Grievance Nurse

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit interpretation, contract ... About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring...high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and benefit… more
    Brighton Health Plan Solutions, LLC (10/05/25)
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  • Disease Management Nurse - Remote

    Sharecare (Raleigh, NC)
    … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
    Sharecare (09/13/25)
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  • Case Manager Registered Nurse PRN

    HCA Healthcare (Asheville, NC)
    …and personal growth, we encourage you to apply for our Case Manager Registered Nurse PRN opening. We review all applications. Qualified candidates will be ... Do you have the PRN career opportunities as a(an) Case Manager Registered Nurse PRN you want with your current employer? We have an exciting opportunity… more
    HCA Healthcare (07/14/25)
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  • Case Management Registered Nurse

    HCA Healthcare (Highlands, NC)
    …important to you, we encourage you to apply for our Case Management Registered Nurse opening. Our team will promptly review your application. Highly qualified ... colleagues in their positions. Join our Team as a(an) Case Management Registered Nurse and access programs to assist with every stage of your career. **Benefits**… more
    HCA Healthcare (09/19/25)
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