Utilization Management Nurse, Prior Authorization Specialist
5 days ago
Brighton Health Plan Solutions is seeking a skilled Utilization Management Nurse to join our team. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the necessary care and services while minimizing unnecessary costs.
Key Responsibilities:
- Perform prospective utilization reviews and first-level determinations for members using evidence-based guidelines, policies, and nationally recognized clinical criteria.
- Identify potential Third-Party Liability and Coordination of Benefit Cases and notify appropriate parties/departments.
- Collaborate with healthcare partners to ensure timely review of services and care.
- Provide referrals to Case Management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
- Develop and review member-centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards.
Requirements:
- Current licensed LPN or Registered Nurse (RN) with state licensure.
- Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
- Ability to work independently and adapt to a high-paced and changing environment.
- Working knowledge of URAC and NCQA.
- 2+ years of experience in a UM team within a managed care setting.
About Brighton Health Plan Solutions
We are a healthcare enablement company that partners with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to provide flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, proprietary provider networks, and innovative technology platforms.
Our Mission:
Transform the health plan experience by bringing outstanding products and services to our partners.
Our Vision:
Redefine healthcare quality and value by aligning the incentives of our partners in powerful and unique ways.
Equal Opportunity Employer:
We are an equal opportunity employer and welcome diversity in the workplace.
-
Utilization Manager
2 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJob SummaryWe are seeking a highly skilled Utilization Manager to join our team at UNC Health. As a Utilization Manager, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct clinical reviews to ensure medical necessity and appropriateness of patient careCollaborate with...
-
RN Utilization Manager
4 days ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJob SummaryWe are seeking a highly skilled RN Utilization Manager to join our team at UNC Health. This role will be responsible for conducting clinical reviews, facilitating patient movement, and ensuring optimal patient outcomes.Key ResponsibilitiesConduct admission reviews and status change reviews within 24 hours of patient admission to ensure...
-
RN Utilization Manager
3 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJob SummaryWe are seeking a skilled RN Utilization Manager to join our team at UNC Health. As a key member of our care management team, you will play a critical role in ensuring the optimal use of healthcare resources while promoting high-quality patient care.ResponsibilitiesClinical Review Process: Conduct admission reviews and status change reviews within...
-
RN Utilization Manager
2 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJob SummaryWe are seeking a skilled RN Utilization Manager to join our team at UNC Health. As a key member of our care management team, you will play a critical role in ensuring the efficient and effective delivery of patient care.ResponsibilitiesClinical Review Process: Conduct admission reviews and status change reviews within 24 hours of patient admission...
-
Utilization Manager RN
3 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJob SummaryWe are seeking a highly skilled Utilization Manager RN to join our team at UNC Health. As a key member of our care management team, you will play a critical role in ensuring the quality and efficiency of patient care.ResponsibilitiesConduct clinical reviews to ensure medical necessity and appropriateness of patient careCollaborate with...
-
Travel Nurse ICU Specialist
4 days ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Title: Travel Nurse ICU SpecialistNurse First is seeking a skilled Travel Nurse ICU Specialist to join our team in Chapel Hill, North Carolina.Job Description & RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNEmployment Type: TravelNurse First Job ID # Our company offers a competitive pay package based on 12 hour shifts and 36 hours per...
-
Travel Nurse ICU Specialist
3 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States Wellspring Nurse Source Full timeJob Title: Travel Nurse ICU SpecialistWellspring Nurse Source is seeking a skilled travel nurse ICU specialist to join their team in Chapel Hill, North Carolina.Job Details:Specialty: ICU - Intensive Care UnitDiscipline: RNDuration: 13 weeksShift: 12 hours, daysEmployment Type: TravelAs a travel nurse ICU specialist, you will have the opportunity to work...
-
Travel Nurse ICU Specialist
4 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States Wellspring Nurse Source Full timeJob Title: Travel Nurse ICU SpecialistWellspring Nurse Source is seeking a skilled travel nurse ICU specialist to join their team in Chapel Hill, North Carolina.Job Description & RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelThe ideal candidate will have...
-
Travel Nurse RN PCU Specialist
2 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States Wellspring Nurse Source Full timeWe are seeking a skilled Travel Nurse RN PCU Specialist to join our team at Wellspring Nurse Source. This is a fantastic opportunity to work in a dynamic and supportive environment.Job DetailsSpecialty: PCU - Progressive Care UnitDiscipline: RN - Registered NurseEmployment Type: TravelShift: 12 hours, daysHours per Week: 36As a Travel Nurse RN PCU...
-
Financial Specialist
4 days ago
Saint-Aubin-sur-Gaillon, Normandie, United States University of North Carolina Full timeJob SummaryWe are seeking a highly organized and detail-oriented Financial Specialist to join our team at the University of North Carolina at Chapel Hill. As a key member of our Finance and Operations Division, you will be responsible for managing sponsored student accounts, ensuring timely and accurate billing, and working closely with the Collections...
-
Practical Nursing Specialist
2 months ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC Health Full timeJoin Our Team as a Practical Nursing Specialist*This position qualifies for a $1,200 commitment incentive, paid in one (1) installment after the first six (6) month period of work is completed.About Us:Become part of an inclusive organization with over 40,000 diverse employees, dedicated to enhancing the health and well-being of the unique communities we...
-
Travel RN
2 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States Protouch Staffing Full timeJob SummaryProtouch Staffing is seeking a skilled Registered Nurse to join our team as a Travel RN - Endoscopy Specialist. This is a fantastic opportunity to work in a dynamic environment and contribute to the delivery of high-quality patient care.ResponsibilitiesEducation and Professional DevelopmentParticipate in identifying and meeting learning needs of...
-
Travel Nurse Case Manager
5 days ago
Saint-Aubin-sur-Gaillon, Normandie, United States Wellspring Nurse Source Full timeTravel Nursing Job OpportunityWellspring Nurse Source is seeking a skilled travel nurse RN Case Manager to join their team.Job RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 14 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelAs a travel nurse RN Case Manager, you will have the opportunity to work with a dedicated team and...
-
Radiologic Technologist
1 month ago
Saint-Aubin-sur-Gaillon, Normandie, United States UNC REX Healthcare Full timeJob SummaryWe are seeking a skilled Radiologic Technologist to join our team at UNC REX Healthcare. As a Diagnostic Imaging Specialist, you will be responsible for providing high-quality diagnostic imaging services to patients, while maintaining a safe and efficient work environment.Key ResponsibilitiesDiagnostic Imaging Procedures: Perform and teach...
-
Nurse Manager
6 days ago
Saint-Aubin-sur-Gaillon, Normandie, United States Incredible Health Full timeIncredible Health is actively hiring for a Registered Nurse - Assistant Manager Case Management position in the Chapel Hill, NC area. We are seeking experienced nurses with expertise in areas such as Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway, Director, Manager, Navigator, Supervisor, Utilization Review, or VP. The...
-
Travel Nurse ICU Specialist
1 month ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Opportunity: ICU Travel NurseNurse First is seeking a skilled ICU travel nurse to join our team in Chapel Hill, North Carolina.Job DetailsSpecialty: ICU - Intensive Care UnitDiscipline: RN - Registered NurseDuration: 12 weeksShift: 12 hours, nightsEmployment Type: TravelNurse First offers a competitive pay package based on 12 hour shifts and 36 hours per...
-
Travel Nurse ICU Specialist
1 month ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Opportunity: ICU Travel NurseNurse First is seeking a skilled ICU travel nurse to join our team in Chapel Hill, North Carolina.Job DetailsSpecialty: ICU - Intensive Care UnitDiscipline: RN - Registered NurseDuration: 12 weeksShift: 12 hours, nightsEmployment Type: TravelNurse First offers a competitive pay package based on 12 hour shifts and 36 hours per...
-
Travel Nurse Oncology Specialist
1 month ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Title: Travel Nurse RN OncologyNurse First is seeking a skilled Travel Nurse RN Oncology professional to join our team in Chapel Hill, North Carolina.Job Description & RequirementsSpecialty: OncologyDiscipline: RNDuration: 12 weeks36 hours per weekShift: 12 hours, flexibleEmployment Type: TravelNurse First offers a competitive pay package based on 12...
-
Travel Nurse Oncology Specialist
1 month ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Opportunity: Travel Nurse RN OncologyNurse First is seeking a skilled travel nurse RN to join our team in a travel nursing position in Oncology.Job DetailsSpecialty: OncologyDiscipline: RNDuration: 12 weeks36 hours per weekShift: 12 hours, flexibleEmployment Type: TravelNurse First offers a competitive pay package based on 12 hour shifts and 36 hours per...
-
Travel Nurse ICU Specialist
4 weeks ago
Saint-Aubin-sur-Gaillon, Normandie, United States Nurse First Full timeJob Opportunity: ICU Travel Nurse RNNurse First is seeking a skilled ICU travel nurse RN to join our team in Chapel Hill, North Carolina.Job DetailsSpecialty: ICU - Intensive Care UnitDiscipline: RNDuration: 12 weeksHours: 36 hours per weekShift: 12 hours, nightsEmployment Type: TravelNurse First offers a competitive pay package based on 12 hour shifts and...