Utilization Review Specialist
1 month ago
Utilization Review Specialist (PRN) | Raleigh Oaks Behavioral Health | Garner, North CarolinaAbout the Job:Schedule: 20 hours per week, between the hours of 8:30am-5pm M-FThe Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.Roles and Responsibilities:•Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes patient's condition and need for hospitalization.•Communicates directly with physicians and other providers with respect to specific inquires and perceived trends of issues as they relate to utilization management.•Appeals all denials ensuring accuracy of information and effective coordination of correspondence. Initiates, coordinates, and monitors the appeal process. Provides information to physicians to assist them in their role in appeals.•Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.•Maintains accurate documentation and files as it relates to utilization management.•Provides ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.•Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each instance to determine if corrective action was taken. Notifies supervisor if corrective action is not completed.•Coordinates information and findings with the business office to help recognize or resolve possible payment problems.•Monitors patient length of stay and extensions and informs clinical and medical staff on issues that may impact length of stay. Investigates short term length of stays and endeavor to create alternate financial planning which would offer the patient extended days of treatment. Participates in discharge planning as required.•Gathers and develops 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.•Conducts quality reviews for medical necessity and services provided. Facilitates peer review calls between facility and external organizations. Identifies potential review problems and discuss them with multi-disciplinary team and/or administration.•Acts as liaison between managed care organizations and the facility professional clinical staff.•Assists with any problems encountered during on-site or telephone reviews by the third-party payers or review organization, when necessary.•Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field required.•Two or more years of direct clinical experience in a psychiatric or mental health setting required.•Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.Why Raleigh Oaks Behavioral Health?Raleigh Oaks Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Raleigh Oaks Behavioral Health is an EOE.Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
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Licensed Clinical Addiction Specialist
2 weeks ago
Garner, United States Restoration Family Full timeLicensed Clinical Addiction Specialist The primary purpose of the Licensed Clinical Addiction Specialist (LCAS) is to provide clinical supervision of Substance Abuse Intensive Outpatient Treatment Program to include supervision of the Qualified Professional, Certified Alcohol and Drug Counselors, Substance Abuse Interns and Counselors, and Patient Care...
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Medical Biller Specialist
2 hours ago
Garner, United States Carolina Elite Women's Care Full timeJob DescriptionJob DescriptionWelcome to your new work family! Carolina Elite Women's Care is seeking a highly motivated, detail oriented Medical Biller to join our growing office.IN OFFICE HOURSMonday-Thursday 8:00am-5:00pmFriday 8:00am-12:00pmJOB RESPONSIBILITIESChecking eligibility and benefits verification for treatments and proceduresObtaining...
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Condition Monitoring Analyst
7 days ago
Garner, United States Gregory Poole Full timePRIMARY FUNCTION: This position will proactively support GPEC equipment and GPEC customers' equipment by analyzing Product Link fault codes, oil sample results, machine inspection reports, equipment repair history, site conditions, and providing reports and recommendations based on this data. ESSENTIAL DUTIS: Provide real time condition monitoring and...
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Medical Technologist II
3 weeks ago
Garner, United States WakeMed Full timeAbout WakeMed: 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 Med Lab...
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Medical Technologist II
3 weeks ago
Garner, United States WakeMed Full timeAbout WakeMed: Highlights: Sign-On Bonus and/or Relocation Incentive available for select positions 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....
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Staff Psychiatrist
5 days ago
Garner, United States Summit BHC Full timeStaff Psychiatrist | Raleigh Oaks Behavioral Health | Garner, North CarolinaAbout the Job:The Psychiatrist is responsible for the medical and psychiatric aspects of admitting and treating patients. Responsible for the initial and continued assessment of patients and for their treatment ensuring the existence of an up-to-date treatment plan appropriate to the...
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Staff Psychiatrist
2 weeks ago
Garner, United States Summit BHC Full timeStaff Psychiatrist | Raleigh Oaks Behavioral Health | Garner, North Carolina About the Job: The Psychiatrist is responsible for the medical and psychiatric aspects of admitting and treating patients. Responsible for the initial and continued assessment of patients and for their treatment ensuring the existence of an up-to-date treatment plan appropriate to...
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Medical Technologist II
2 weeks ago
Garner, United States WakeMed Full timeJob DescriptionAbout WakeMed:Highlights:Sign-On Bonus and/or Relocation Incentive available for select positionsServing 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...
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Medical Technologist II
1 month ago
Garner, United States WakeMed Full timeJob DescriptionAbout WakeMed: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.EOEPosition Information:The Med...
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Medical Technologist II
2 weeks ago
Garner, United States WakeMed Full timeJob DescriptionAbout WakeMed:Highlights:Sign-On Bonus and/or Relocation Incentive available for select positionsServing 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...
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Logistics Manager
7 days ago
Garner, United States Parksite Full timeJob DescriptionJob DescriptionBecome an Employee Owner with Parksite! Earn more from your hard work!Parksite is looking for a Logistics Manager for our Garner, NC location! The Logistics Manager will oversee a busy distribution center environment including process improvement, team development and supply chain management. This position directs all...
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Logistics Manager
16 hours ago
Garner, United States Parksite Full timeJob DescriptionJob DescriptionBecome an Employee Owner with Parksite! Earn more from your hard work!Parksite is looking for a Logistics Manager for our Garner, NC location! The Logistics Manager will oversee a busy distribution center environment including process improvement, team development and supply chain management. This position directs all...
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Medical Technologist II
1 month ago
Garner, United States WakeMed Full timeAbout WakeMed:Highlights:Sign-On Bonus and/or Relocation Incentive available for select positionsServing 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...
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Medical Technologist II
1 month ago
Garner, United States WakeMed Full timeAbout WakeMed: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.EOEPosition Information:The Med Lab Scientist...
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Senior Sales Engineer
7 days ago
Garner, United States Gregory Poole Full timeSenior Sales Engineer 3201 Integrity Dr, Garner, NC 27529, USA Req #1235 Tuesday, May 14, 2024 PRIMARY FUNCTION : This person will be responsible for the promotion, sales and engineering of new and used industrial stationary Air Compressor systems and the ancillary equipment connected. The sales territory will cover an agreed upon area between the A/C Sales...
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HVAC Dispatcher
4 days ago
Garner, United States Biggs HVAC, Plumbing & Electrical Full timeJob DescriptionJob DescriptionWe're looking for an energetic and forward-thinking Dispatcher to join our team. As a Dispatcher, you'll play a vital role in maintaining our service technicians' daily schedules. Your focus will be on ensuring smooth job dispatching and coordinating with customers to provide precise logistics regarding job locations...
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Field Operations Technician
7 days ago
Garner, United States OnSight PROS Full timeJob DescriptionJob DescriptionSalary: $18OnSight PROS is hiring for a Field Operations Technician, we are looking for a dynamic, self-motivated individual to join our team. No Prior Experience Required - We'll Shape You for Success!OnSight PROS specializes in providing third-party property condition reporting services for rental properties. Our PROS...
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Radiologic Technologist
57 minutes ago
Garner, United States UNC Health Care Full timeDescription Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve. Join the UNC Health Team as a Rad Tech! Summary: Provides and teaches diagnostic procedures in the field of radiologic imaging. Maintains knowledge concerning radiation protection...
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Medical Director
5 days ago
Garner, United States Summit BHC Full timeMedical Director - Psychiatrist | Raleigh Oaks Behavioral Health | Garner, North CarolinaAbout the Job:The Medical Director is responsible for leadership, quality assurance, oversight and overall medical management of the hospital within the boundaries of state and federal regulations and accreditation standards. Responsibilities include planning, organizing...
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Business Insurance Client Manager
1 month ago
Garner, United States Jones Insurance Agency, Inc. Full timeTitle: Business Insurance Client Manager FLSA Status: ExemptShift: 1stReports to: Commercial Lines Team LeadDepartment: Business Insurance - Commercial LinesEmployment Status: Full-timeSupervisory Responsibilities: NoneDate Created/Last Evaluated: May 2023 Summary This position is directly responsible for assisting in the production of new accounts...
