Current jobs related to Case Manager Utilization Review - Raleigh - WakeMed
-
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMed:Mental Health & Well-Being Hospital - WakeBrook provides innovative solutions to address the mental health issues among adults in our community. Our hospital serves adults in need of inpatient care for psychiatric illnesses. This is an exciting opportunity to be part of a critical service for our community and care for adults who need our help....
-
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedMental Health & Well-Being Hospital - WakeBrook provides innovative solutions to address the mental health issues among adults in our community. WakeBrook will serve adults in need of inpatient care for psychiatric illnesses. This is an exciting opportunity to be part of a critical service for our community and care for adults who need our...
-
Clinical Utilization Review Nurse
1 day ago
Raleigh, North Carolina, United States Alliant Health Solutions Full timeJob SummaryAlliant Health Solutions is seeking a skilled Clinical Utilization Review Nurse to join our team. As a member of our professional multi-disciplinary work team, you will perform retrospective reviews of medical records, document clearly the rationale for all review decisions, and evaluate clinical information to approve cases that meet criteria.The...
-
Clinical Utilization Review Specialist
2 weeks ago
Raleigh, North Carolina, United States Centene Corporation Full timeJob Title: Clinical Utilization Review SpecialistJoin Centene Corporation, a leading healthcare company, as a Clinical Utilization Review Specialist. In this role, you will play a critical part in ensuring the quality and appropriateness of care for our 28 million members.Job Summary:We are seeking a highly skilled Clinical Utilization Review Specialist to...
-
Utilization Review Nurse
2 days ago
Raleigh, North Carolina, United States Alliant Health Solutions Full timeJob SummaryAlliant Health Solutions is seeking a skilled Utilization Review Nurse to join our team in North Carolina. As a key member of our Utilization Review team, you will be responsible for conducting medical reviews of requests for Emergency Medicaid Services to ensure compliance with federal guidelines and state policy.Key Responsibilities:Conduct...
-
Clinical Utilization Management Nurse
2 weeks ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedServing the community since 1961, WakeMed Health & Hospitals is a leading provider of health services in Wake County. Our mission is to improve the health and well-being of our community by providing outstanding and compassionate care.Position InformationAs a Clinical Utilization Management Nurse, you will be responsible for performing a...
-
Utilization Management Nurse Specialist
4 weeks ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedServing the community since 1961, WakeMed Health & Hospitals is a leading provider of health services in Wake County.We are committed to improving the health and well-being of our community by providing outstanding and compassionate care.For more information, visit our website.Position InformationAs a Utilization Management Nurse, you will be...
-
Clinical Utilization Management Nurse
3 weeks ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedServing the community since 1961, WakeMed Health & Hospitals is a leading provider of health services in Wake County. Our mission is to improve the health and well-being of our community by delivering outstanding and compassionate care.Position InformationWe are seeking a skilled Utilization Management Nurse to join our team. As a key member of...
-
Nurse Case Manager
21 hours ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMed:Serving the community with excellence, WakeMed Health & Hospitals is a leading provider of health services in Wake County. Our mission is to improve the health and well-being of our community, and we are committed to providing outstanding and compassionate care. For more information, visit our website.Position Information:The Nurse Case Manager...
-
Nurse Case Manager
2 weeks ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedWakeMed Health & Hospitals is a leading provider of health services in Wake County, serving the community since 1961. Our mission is to improve the health and well-being of our community by providing outstanding and compassionate care.Job SummaryThe Nurse Case Manager is a Registered Nurse responsible for providing patient case management...
-
Clinical Utilization Specialist
1 month ago
Raleigh, North Carolina, United States WakeMed Full timeAbout WakeMedServing the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. Our mission is to improve the health and well-being of our community by providing outstanding and compassionate care.Job SummaryWe are seeking a skilled Clinical Utilization Specialist to join our team. As a key member of our...
-
External Quality Review Contract Manager
3 days ago
Raleigh, North Carolina, United States The Carolinas Center for Medical Excellence Full timeJob Title: External Quality Review Contract ManagerWe are seeking a highly skilled External Quality Review Contract Manager to join our team at Constellation Quality Health. As a key member of our organization, you will be responsible for the effective and efficient operation of assigned contracts and services.Key Responsibilities:Oversee and coordinate all...
-
RN Case Manager
4 weeks ago
Raleigh, North Carolina, United States Elevance Health Full timeJob Title: RN Case ManagerLocation: Field associates spend 4-5 days per week in-person with patients, members or providers in the state of North Carolina.Job Summary: We are seeking a skilled RN Case Manager to join our team. As a RN Case Manager, you will be responsible for the overall management of member's case within the scope of licensure, providing...
-
Cardiology Physician Clinical Review Specialist
4 weeks ago
Raleigh, North Carolina, United States Evolent Health Full timeAbout the RoleEvolent Health is seeking a skilled Cardiology Physician Clinical Reviewer to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that patients receive the best possible care.Key ResponsibilitiesServe as the specialty match reviewer in Cardiology cases that do not initially meet the...
-
RN Case Manager
2 weeks ago
Raleigh, North Carolina, United States Elevance Health Full timeJob Title: RN Case ManagerJoin Elevance Health as a RN Case Manager and play a vital role in improving the lives of our members and communities.About the Role:We are seeking a skilled and compassionate RN Case Manager to join our team. As a RN Case Manager, you will be responsible for managing the overall care of our members, ensuring they receive the best...
-
Recovery Case Manager
4 days ago
Raleigh, North Carolina, United States Raleigh Dream Center Full timeJob Summary:The Raleigh Dream Center seeks a skilled Recovery Case Manager to facilitate the independence of our residents by providing case management services and connecting them with community resources and service providers. The ideal candidate will work with each resident to develop, implement, and monitor individual case plans with the goal of...
-
Physician Clinical Reviewer
3 weeks ago
Raleigh, North Carolina, United States Evolent Health Full timeAbout the RoleEvolent Health is seeking a skilled Physician Clinical Reviewer to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that patients receive the best possible care.Key ResponsibilitiesReview medical necessity guidelines and parameters to ensure consistency in the MD review process.Discuss...
-
Clean Utilities Project Manager
5 days ago
Raleigh, North Carolina, United States Piper Companies Full timeClean Utilities Project Engineer Job DescriptionPiper Companies is seeking a highly skilled Clean Utilities Project Engineer to oversee the design, installation, and commissioning of critical utilities and equipment for projects located in Raleigh, NC, and abroad. The ideal candidate will have 5-10 years of experience in clean utilities, preferably in...
-
Clean Utilities Project Manager
3 weeks ago
Raleigh, North Carolina, United States Piper Companies Full timeClean Utilities Project Engineer Job DescriptionPiper Companies is seeking a highly skilled Clean Utilities Project Engineer to oversee the design, installation, and commissioning of critical utilities and equipment for a brand-new manufacturing facility in Raleigh, NC. This role requires the ability to travel abroad to countries like Italy and...
-
RN Case Manager
4 weeks ago
Raleigh, United States Elevance Health Full timeLocation: Field associates spend 4-5 days per week in-person with patients, members or providers in the state of North Carolina. The RN Case Manager (LTSS Service Coordinator- RN) is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in...
Case Manager Utilization Review
4 months ago
About WakeMed:
Mental Health & Well-Being Hospital - WakeBrook provides innovative solutions to address the mental health issues among adults in our community.
WakeBrook will serve adults in need of inpatient care for psychiatric illnesses. This is an exciting opportunity to be part of a critical service for our community and care for adults who need our help.
WakeMed will also open a 150-bed Mental Health & Well-Being hospital in Garner, NC in 2027, which will offer additional opportunities when it is close to completion.
Benefits/Highlights:
• Sign-On Bonus available for select positions
• Competitive Benefits Package
• Tuition Reimbursement
• Public Service Loan Forgiveness
• Free Onsite Parking
Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org.
EOE
Position Information:
The Behavioral Health Case Manager for Utilization Review is responsible for assisting patients and families in recognizing and managing mental health substance use and psychosocial issues and assists with development of disposition communication and execution of discharge plan. Assists with natural support community and patient engagement strategies including resource navigation relapse and prevention planning referral management warm handoff communication etc. Functions as a resource and placement specialist for the team with strong working knowledge of MH/SU levels of care. Assists patient with self-management skills educational materials advocacy resources and/or support groups so they can be full participants in their treatment and recovery. Collaborates with the Network for Advanced Behavioral Health for successful connection and patient engagement regarding inpatient placement and outpatient plans. Monitors the referral platform to ensure timely placement and efficient communication. Will conduct safety assessments; arrange transportation SDOH migration and patient/family education as needed. Anticipates and pro-actively avoids potential delays in disposition. Reviews and assesses appropriateness of patient admission/continued stay. Completes concurrent reviews and monitors the use of insurance benefits to maximize service to patients. Provides timely pertinent insurance benefits information to clinical staff so that they will provide care within patients? benefits package and thereby optimize third party payment for services. Assists physicians in preparing appeals when payment has been denied by insurance companies. Assists in the implementation of the Hospital Utilization Review Plan. Provides consultation and/or education to clinical staff regarding monitoring studies and medical records reviews. Participates in the preparation and tracking of the Involuntary Commitment processes and represents the hospital in involuntary hearings process.
Experience Requirements:
2 Years Clinical - Case Management Or Related Position Experience Required
Education Required:
Master's Degree Social Work Or Counseling Or Marriage and Family Therapy Or Psychology Required
Licensure/Certification Requirements:
Licensed Marriage and Family Therapist Or Licensed Clinical Social Worker Or Licensed Clinical Mental Health Counselor Preferred - And Certified Notary Required - Within 1 Year of Hire
Hours of Work:
Monday - Friday, 8:00am - 4:30pm
Weekend Requirements:
No Weekends
Call Requirements:
None
