NewTravel Utilization Review Nurse - $2,336 per week Travel Nurses, Inc.Travel Utilization Review Nurse - $2,336 per weekKinston, NCTravel Nurses, Inc. is a nurse-founded and operated healthcare staffing agency connecting nurses and allied health professionals with opportunities nationwide. Since 1988, we’ve grown from supporting operating room teams in the Mid-South to serving a wide range of specialties across the country.
Newstaff - Registered Nurse (RN) - Case Management - $39-58 per hour Perm Staff Jobsstaff - Registered Nurse (RN) - Case Management - $39-58 per hourRutherfordton, NC$39–$58 / hourThe Post-Acute Transitions Specialist will ensure appropriate patient placement through screenings and assessments in collaboration with SNF Discharge Planners & Inter- Disciplinary Teams, Ambulatory Care Managers, MHP Care Managers, BPCI Transitions Care Coordinator, practice referral coordinators, physicians, and CarePartners Post-Acute service line team members. They will maximize positive financial outcomes for designated patient populations, intervening at key points in the disease process by facilitating appropriate Post-Acute placement, participating in Goals of Care/Advanced Care Planning dialogue and effective transitions to prevent readmissions, and lower total cost of care thru the appropriate utilization of Post-Acute services.
Newstaff - Registered Nurse (RN) - Case Management - $21-38 per hour Perm Staff Jobsstaff - Registered Nurse (RN) - Case Management - $21-38 per hourFranklin, NC$21–$38 / hourThe Post-Acute Transitions Specialist will ensure appropriate patient placement through screenings and assessments in collaboration with SNF Discharge Planners & Inter- Disciplinary Teams, Ambulatory Care Managers, MHP Care Managers, BPCI Transitions Care Coordinator, practice referral coordinators, physicians, and CarePartners Post-Acute service line team members. They will maximize positive financial outcomes for designated patient populations, intervening at key points in the disease process by facilitating appropriate Post-Acute placement, participating in Goals of Care/Advanced Care Planning dialogue and effective transitions to prevent readmissions, and lower total cost of care thru the appropriate utilization of Post-Acute services.
Registered Nurse (RN) - Case Manager Frye Regional Medical CenterRegistered Nurse (RN) - Case ManagerHickory, NCFrye Regional Medical Center is a 355-bed hospital offering acute care hospital, home to the Frye Regional Brain Center, Heart Center, Cancer Center, Emergency Services, General and Vascular Surgery, Orthopedics, Surgical Weight Loss, Women's Birthing Center and Inpatient Rehabilitation that has been offering exceptional care to the Hickory NC community since 1911. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities.
NewCare Manager RN - Per Diem UnitedHealth GroupCare Manager RN - Per DiemHighlands, ME$28.27–$50.48 / hourThe Care Manager RN - Per Diem provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients/caregivers and multidisciplinary healthcare team to arrange appropriate post discharge services and optimal transitions in care. Through clinical care coordination drives efficient utilization of resources to reduce length of stay, improve patient flow and throughput, limits variation by applying innovative and evidence-based practice, and to reduce the risk of readmission.
NewCase Manager (RN) Home Health Duke HealthCase Manager (RN) Home HealthDurham, NCDevelop plan of care for aides, assign care to aides based on the skills of the aide, the availability of the aide for patient care continuity, patient preference (when possible), and other considerations as determined by the patient’s care needs. Duke HomeCare and Hospice provides innovative and thoughtful care by using an interdisciplinary team approach to achieve the best possible outcomes for patients, families and the communities for which they serve.
CLINICAL NURSE IV LEADER - PEDS CARDIAC STEPDOWN Duke HealthCLINICAL NURSE IV LEADER - PEDS CARDIAC STEPDOWNDurham, NCThe Peds Cardiac Stepdown (Unit 3A) located in Duke Central Tower at Duke University Hospital has 17 beds serving infants through young adult patients with congenital heart disease, cardiac transplant needs, and complex trach/ventilator-dependent care. Incentives & Total Rewards: Relocation Assistance: Relocation is offered to employees relocating from a permanent residence located at least 50 miles from Duke University Hospital.
Newstaff - Registered Nurse (RN) - System Float - $34-58 per hour Perm Staff Jobsstaff - Registered Nurse (RN) - System Float - $34-58 per hourAsheville, NC$34–$58 / hourThe Clinical Team Lead ensures effective utilization of staffing resources across the Mission Health System by coordinating, educating, organizing and engaging CarePartners Internal Staffing nursing and therapy staff; while collaborating with Mission System leaders and educators to provide competent and safe staff to serve the Mission System as needed. Ensures effective utilization of staffing resources by evaluating staffing needs of the continuum, making staffing adjustments, and recruiting new staff to work additional hours in support of the Internal Staffing Agency.
Registered Nurse Post Acute Transition Specialist CarePartnersRegistered Nurse Post Acute Transition SpecialistMorganton, NCThe Post-Acute Transitions Specialist will ensure appropriate patient placement through screenings and assessments in collaboration with SNF Discharge Planners & Inter- Disciplinary Teams, Ambulatory Care Managers, MHP Care Managers, BPCI Transitions Care Coordinator, practice referral coordinators, physicians, and CarePartners Post-Acute service line team members. They will maximize positive financial outcomes for designated patient populations, intervening at key points in the disease process by facilitating appropriate Post-Acute placement, participating in Goals of Care/Advanced Care Planning dialogue and effective transitions to prevent readmissions, and lower total cost of care thru the appropriate utilization of Post-Acute services.
Registered Nurse Case Manager PACE Home Care CarePartnersRegistered Nurse Case Manager PACE Home CareBrevard, NCAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home Health Aides, Homecare Services Non-Skilled Aides and the Homecare Schedulers.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNGastonia, NCOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
NewNurse Manager, Operations (NMO) ICU Duke HealthNurse Manager, Operations (NMO) ICUDurham, NCCoordinate the activities of nursing staff with other hospital personnel; accountable for the effective and efficient operation of the unit and staff including ensuring that orders, treatments, plans of care, clinical pathways are being carried out in a manner supportive of patient care and recovery. With 388 beds it is the second largest of Duke Health's four hospitals and offers a comprehensive range ofmedical, surgical, and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services.
NewNurse Manager, Operations (NMO) Duke Cancer Center North Durham Duke HealthNurse Manager, Operations (NMO) Duke Cancer Center North DurhamDurham, NCCoordinate the activities of nursing staff with other hospital personnel; accountable for the effective and efficient operation of the unit and staff including ensuring that orders, treatments, plans of care, clinical pathways are being carried out in a manner supportive of patient care and recovery. With 388 beds it is the second largest of Duke Health's four hospitals and offers a comprehensive range ofmedical, surgical, and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services.
Newstaff - Registered Nurse (RN) - Case Manager, Home Health - $58+ per hour Perm Staff Jobsstaff - Registered Nurse (RN) - Case Manager, Home Health - $58+ per hourWaynesville, NCAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home Health Aides, Homecare Services Non-Skilled Aides and the Homecare Schedulers.
Newstaff - Registered Nurse (RN) - Case Manager, Home Health - $34-58 per hour Perm Staff Jobsstaff - Registered Nurse (RN) - Case Manager, Home Health - $34-58 per hourAsheville, NC$34–$58 / hourAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home Health Aides, Homecare Services Non-Skilled Aides and the Homecare Schedulers.
NewTravel Nurse RN - Case Manager - $2,005 per week in Chapel Hill, NC TravelNurseSourceTravel Nurse RN - Case Manager - $2,005 per week in Chapel Hill, NCChapel Hill, NC$2,005Job Title: Care Manager Profession: RN Specialty: Case Management Duration: 13 weeks Shift: Days Hours per Shift: 40 Experience: Two (2) years of health care experience as a Registered Nurse License: Licensed to practice as a Registered Nurse in the state of North Carolina Certifications: Nursing Diploma or ADN/ASN from an accredited school of Nursing Must-Have: DISCHARGE PLANNING CRITICAL THINKING CASE MANAGEMENT UTILIZATION REVIEW PATIENT ASSESSMENT Description: The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Provide education on community resources, support groups, and appropriate resources to patients, families, and the care team.
NewTravel Nurse RN - Case Manager - $2,446 per week in Kinston, NC TravelNurseSourceTravel Nurse RN - Case Manager - $2,446 per week in Kinston, NCKinston, NC$2,446Job Title: Case Manager - RN Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day Hours per Shift: 8 Experience: Minimum of 4 years of experience as a Registered Nurse is required. This includes promoting continuity of care and cost-effectiveness through integrated functions of case management, utilization review, and discharge planning.
NewTravel Nurse RN - Case Manager - $2,572 per week in Kinston, NC TravelNurseSourceTravel Nurse RN - Case Manager - $2,572 per week in Kinston, NCKinston, NC$2,571.60Modified 4:00:00 AM Account Manager: Haley Hindes Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Job Requirements & Qualifications Previous Charge Experience: - Years of Experience: 4 Patient Ratio Experience: Charting System Experience: Required Charting System Name: Epic Community Hospital Experience: - LTAC Experience: - Trauma Level I Experience: - Trauma Level II Experience: - Travel Experience Required: Yes Certifications: BLS, ACM/CCM*Skills: Acute Hospital, Admission Criteria, Admission Criteria, Appeals and Denials*, Appeals and Denials*, Care coordination, Concurrent Review, Concurrent Review, Continued Stay Reviews, Continued Stay Reviews, Discharge Planning, Emergency Department, ICU, Medical Necessity, MS, Needs Assessment/ Order DME, Retrospective Review*, Retrospective Review*, SDU/PCU/IMC/Obs, Utilize InterQual Criteria, Utilize InterQual Criteria, Utilize Milliman Guidelines, Utilize Milliman Guidelines, Women s Services, PASRR/FL2*, IM/MOON Unit Details Staffing & Scheduling Scheduling Type: block Patient Ratios Days: 20 Patient Ratios Nights: - Patient Ratios Weekends: 70 Float Required: - Call Required: - Weekend Coverage: - Number of Weekend Shifts Per Contract: All Pre-Approved Time Off: - Orientation Hours: 24 Facility & Patient Care Details Patient Age Groups: Neonates, Infants, Adults, Geriatrics Daily Census: 70 Number of Visits Per Day: - Number of Rooms: - Number of Beds: - Additional Unit Information Interdisciplinary Support: - Patient Diagnoses: - Special Procedures/Unit Details: - Special Equipment: - #Tier1 Travel Compliance A current Nursys report dated within the past 7 days must be included with the submittal email. Average daily census Weekends: 70Days: 20Orientation: 24 hoursThe purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs.
NewTravel Nurse RN - Acute Care - $1,900 to $2,100 per week in Chapel Hill, NC TravelNurseSourceTravel Nurse RN - Acute Care - $1,900 to $2,100 per week in Chapel Hill, NCChapel Hill, NC$1,900–$2,100TravelNurseSource is working with Lancesoft Inc to find a qualified Acute Care RN in Chapel Hill, North Carolina, 27514! Responsibilities Perform patient assessments and develop individualized care plans.
NewAssociate Medical Device Sales Representative Medical Sales CollegeAssociate Medical Device Sales RepresentativeGastonia, NCMuch like the specialized technical certifications and self-funded training tracks required to enter fields like veterinary technology or nursing, this program requires a personal tuition investment from the candidate (with financing options and flexible payment plans available for qualified applicants). Pathway Requirement: Successful completion of the required Medical Sales College program (such as TotalOrtho, TotalOrtho+, or specialized diagnostic/orthopedic tracks) serves as the prerequisite industry baseline for candidates lacking direct field experience.
NewRegistered Nurse (RN) - Case Manager, Home Health - $23-44 per hour Perm Staff JobsRegistered Nurse (RN) - Case Manager, Home Health - $23-44 per hourEast Flat Rock, NC$23–$44 / hourAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Act as the liaison between the contracted home health agency and the PACE program coordinating homecare Nurses, Home Health Aides, Homecare Services Non-Skilled Aides and the Homecare Schedulers.
NewLTSS Service Care Manager AxelonLTSS Service Care ManagerGreensboro, NCRemoteWork collaboratively with a team including utilization management, quality, transition of care, care managers, coordinators, and navigators. Develop, assess, and coordinate holistic care management activities to support quality, cost-effective healthcare outcomes.
NewOperations Coordinator - PRN Duke HealthOperations Coordinator - PRNDurham, NC$8–$12 / hourThe Operations Coordinator collaborates with healthcare teams, including physicians, nurses, case managers, and support services, to streamline the discharge process, expedite physician order execution, and coordinate the timely transfer of patients. By leveraging their clinical expertise and effective coordination skills, the Operations Coordinator contributes to optimizing resource utilization, reducing length of stay, and promoting efficient and effective healthcare delivery at Duke University Hospital.
Clinical Practice Team Lead Float Pool-RN CarePartnersClinical Practice Team Lead Float Pool-RNRutherfordton, NCThe Clinical Team Lead ensures effective utilization of staffing resources across the Mission Health System by coordinating, educating, organizing and engaging CarePartners Internal Staffing nursing and therapy staff; while collaborating with Mission System leaders and educators to provide competent and safe staff to serve the Mission System as needed. Ensures effective utilization of staffing resources by evaluating staffing needs of the continuum, making staffing adjustments, and recruiting new staff to work additional hours in support of the Internal Staffing Agency.
RN Utilization Manager - Care Management UNC HealthRN Utilization Manager - Care ManagementSmithfield, NC$35.87–$51.57 / hourSummary: Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. Using approved criteria, conducts continued stay and quality reviews to monitor the patients progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective.
Utilization Management Nurse Brighton Health Plan Solutions, LLCUtilization Management NurseChapel Hill, NCFull timeExperience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred. • Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantNC$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Remote Utilization Management/Review Nurse Zp Group LlcRemote Utilization Management/Review NurseCary, NCRemote$65,000–$75,000 / yearLocation: Remote (Eligible in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming). This role applies clinical expertise, regulatory knowledge, and critical thinking to support high-quality, compliant care decisions while collaborating with providers and internal teams.
Utilization Review Nurse UNC HealthUtilization Review NurseKinston, NC$32.48–$38.98 / hourTo accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary; in collaboration with the care team. Responsibilities:Patients/Families, Hospital staff, Medical staff, Community agencies, and Insurance Companies are served by conducting interpersonal relationships in a manner that projects a positive image of the department and hospital.
NewUtilization Review RN Appeals Specialist CaroMont HealthUtilization Review RN Appeals SpecialistGastonia, NCThis position also facilitates collaboration between the Utilization Review Specialists, Medical Staff, Physician Advisor, Nursing staff, Commercial Payers, VA, Managed Medicare Organizations, Medicare, and Medicaid (Center for Medicare/Medicaid Services) to ensure correct admission status as dictated by medical necessity criteria for correct reimbursement for level of care provided and to ensure that any denial is thoroughly reviewed and that an appeal letter, if warranted, is well written and submitted in a timely manner. Additionally, works with outside surgical offices when called upon, to provide Medicare Inpatient Only List knowledge to ensure that surgical procedures are correctly called in and billed appropriately.
Utilization Management Clinician (Tuesday - Saturday) PacificSource Health PlansUtilization Management Clinician (Tuesday - Saturday)NC$70,950–$106,424.99 / yearEducation, Certificates, Licenses: Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner, (PMHNP) credential required. Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions.
NewBehavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Substance Abuse - Flexible Weekend Dayshift - Remote in VA and NC Sentara Healthcare IncBehavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Substance Abuse - Flexible Weekend Dayshift - Remote in VA and NCNCRemoteManaged Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse License (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Weekends, Days, North Carolina, Licensed Substance Abuse Treatment Practitioner, LSATP, Certified Substance Abuse Counselor, CSAC, Licensed Chemical Dependency Counselors, LCDC, American Society of Addiction Medicine (ASAM). Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON).
Utilization Manager (RN) UNC HealthUtilization Manager (RN)Hendersonville, NCFacilitates patient movement to appropriate (acuity) level of care including observation services issues through collaboration with patient/patient representative, multidisciplinary team, third party payers and care managers/social workers. Using approved criteria, conducts initial and continued stay reviews to monitor the patients progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective.
NewUtilization Management Clinician (Tuesday - Saturday) PacificSourceUtilization Management Clinician (Tuesday - Saturday)North CarolinaEducation, Certificates, Licenses: Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner, (PMHNP) credential required. Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions.
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based) AllianceDir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)Morrisville, North CarolinaRemoteMaintain accessible and close working relationships with all applicable department heads and decision makers to develop a more coordinated and streamlined service delivery system for individuals and families throughout the service area. Implement a system to maintain and assure that the authorization of services provided by clinical care staff appropriately address the service needs, types of service, outcomes, and alternatives available to consumers.
NewUtilization Review Nurse (RN) Integrated Resources, IncUtilization Review Nurse (RN)Raleigh, North CarolinaContractorUtilization Review Nurse (RN)A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. Job Description· The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care.·
NewTravel RN Utilization Review Voyage HealthTravel RN Utilization ReviewKinston, North Carolina$2,303–$2,425At Voyage Healthcare, we help connect nurses, therapists, and allied health pros with high-paying travel jobs at top-rated facilities across the U.S. With thousands of openings nationwide, you can earn up to $3,500+ per week (depending on your specialty, location, housing, and benefits)—all while making a real impact on the communities that need you most. We're hiring experienced RN Utilization Review for a 13-week contract in Kinston, North Carolina — earn up to ($2304 - $2425 per week) while providing essential care at a leading facility.
RN Care Manager - (Per Diem) Care Management UNC HealthRN Care Manager - (Per Diem) Care ManagementNC$35.87–$51.57 / hourThe overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. Active Consults - Discuss with appropriate members of the multidisciplinary team when there are barriers to discharge and psychosocial concerns impacting progression of care or readmission risk.
RN Care Manager Case Management UNC HealthRN Care Manager Case ManagementEden, NC$31.04–$44.62 / hourThe Care Manager works collaboratively with healthcare providers, patients, and their families to ensure that patients receive the highest quality of care and support throughout their healthcare journey. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication.
Utilization Manager 10 hour Every Other Weekend Duke UniversityUtilization Manager 10 hour Every Other WeekendDurham, NCWorks collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines for all short-stay Medicare inpatients and outpatients (DUH), all observation encounters, all combined/segmental billing encounter questions, and any encounter sent to the UM MCA from PRMO for patient status/post-bill medical necessity denials/coding questions. Supports denials management by documenting activities related to denials adjudication according to departmental guidelines and actively works to overturn threatened denial activities.
Utilization Review Specialist Vidant Medical CenterUtilization Review SpecialistGreenville, NC$65,520–$95,501.12 / yearECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Travel RN-Utilization Review in Kinston, North Carolina Voyage HealthTravel RN-Utilization Review in Kinston, North CarolinaKinston, North Carolina$2,123–$2,235At Voyage Healthcare, we help connect nurses, therapists, and allied health pros with high-paying travel jobs at top-rated facilities across the U.S. With thousands of openings nationwide, you can earn up to $3,500+ per week (depending on your specialty, location, housing, and benefits)—all while making a real impact on the communities that need you most. We're hiring experienced RN-Utilization Review for a 13-week contract in Kinston, North Carolina — earn up to ($2123 - $2235 per week) while providing essential care at a leading facility.
NewUtilization Specialist Wilmington Treatment CenterUtilization SpecialistWilmington, North CarolinaFull timeGather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. Preferred Licensure : LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
Utilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerCharlotte, NCRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
NewUtilization Specialist Acadia Healthcare Co IncUtilization SpecialistWilmington, NCLICENSES/DESIGNATIONS/CERTIFICATIONS: Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
RN Care Manager - Pineville Clinical Care Management PRN Days Advocate Health and Hospitals CorporationRN Care Manager - Pineville Clinical Care Management PRN DaysCharlotte, North CarolinaCurrent RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting.
RN Care Manager - Pineville Clinical Care Management PRN Days Advocate Aurora Health IncRN Care Manager - Pineville Clinical Care Management PRN DaysCharlotte, NC$38.20–$57.30 / hourCurrent RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting.
RN Care Manager- Atrium Health Stanly Clinical Care Management PT- Weekender Advocate Aurora Health IncRN Care Manager- Atrium Health Stanly Clinical Care Management PT- WeekenderAlbemarle, NC$38.20–$57.30 / hourCurrent RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. Conducts or participates in comprehensive "all-system" needs assessment for identified patients; knowledgeable of appropriate care-related services to match identified needs disease management for health maintenance, and appropriate clinical goal expectations/outcomes for identified population.
Utilization Manager Duke UniversityUtilization ManagerDurham, NCWorks collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines for all short-stay Medicare inpatients and outpatients (DUH), all observation encounters, all combined/segmental billing encounter questions, and any encounter sent to the UM MCA from PRMO for patient status/post-bill medical necessity denials/coding questions. With 388 beds it is the second largest of Duke Healths four hospitals and offers a comprehensive range ofmedical, surgical, and diagnostic services, including orthopedics, weight-loss surgery, womens services, and heart and vascular services.