Medical Director, Utilization & Case Management
Highmark Health
Highmark Health in Raleigh, North Carolina is seeking a Medical Doctor or Doctor of Osteopathic Medicine to join a physician team focused on utilization management. This role involves reviewing escalated cases and determining medical necessity while ensuring compliance with various regulations. The candidate should have at least 5 years in clinical patient care and possess excellent communication and critical thinking skills. Opportunities for multidisciplinary collaboration and project management are available. #J-18808-Ljbffr Highmark Health
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Medical Director, Utilization & Case Management in Raleigh, NC vacancy
- ...Supports patients and families in managing mental health and substance... ...with insurance appeals and utilization reviews. Supports clinical... ...staff with coverage guidance and medical record reviews. Participates... ...process, including case tracking and representing the...Suggested
yourcommission
Raleigh, NC17 hours ago - ...thoughtful, patient‑centered care plans. Provide skilled nursing interventions—including wound care, infusions, catheter care, medication management, post‑operative care, and chronic disease management—tailored to each patient’s goals and condition. Educate and empower...SuggestedFull timeLocal areaMonday to Friday
$238k - $357.5k
...Medical Director Oncology Optum is a global organization that delivers care, aided by technology to help... ...The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes....SuggestedRemote jobFull timeWork experience placement- ...Case Manager (RN) The Case Manager plays a vital role in delivering client-centered services that support patients across the continuum... ...community-based services. You will ensure timely access to medically appropriate care while promoting continuity, quality outcomes...SuggestedTemporary workWork from home
Millennium Physician Group
Raleigh, NC2 days ago - A leading health service provider in Raleigh, North Carolina, is seeking a Case Manager to assist in managing the Patient Case Management Department. This role involves collaboration with physicians and nursing leadership to ensure quality service delivery. Candidates...Suggested
- WakeMed is seeking professionals for the Patient Case Management Department in Raleigh, North Carolina. The role involves managing daily operations, collaborating with interdisciplinary teams, and maintaining clinical competency. A Master's Degree in Social Work is required...
- ...Supports patients and families in managing mental health and substance... ...with insurance appeals and utilization reviews. Supports clinical... ...staff with coverage guidance and medical record reviews. Participates... ...process, including case tracking and representing the...Temporary work
- ...Case Manager The Case Manager is a qualified registered nurse with... ...role, you will report to the Director of Nursing/Director of... ...health strategies and procedures utilizing community resources as applicable... ...condition, responsible for medication reconciliation...Immediate startNight shiftWeekend work
Team Select Home Care
Raleigh, NC4 days ago - ...Job Title: Worker's Compensation Case Manager Type: Full-Time, Contract-to-Hire Schedule:... ...primary liaison between clients, attorneys, medical providers, insurance adjusters, and the... ...files). At least 1 year of experience utilizing legal case management software. Strong...Full timeContract workTemporary workWork at officeLocal areaMonday to Friday
Addison Group
Raleigh, NC2 days ago - ...Join to apply for the Case Manager - PRN role at Duke University Health System 4 days ago... ...beds, it offers a comprehensive range of medical services, including 24-hour emergency care... ...the continuum of care. Ensure optimum utilization of the patient's and the Health System'...Full timeReliefLocal areaRelocation package
Duke University Health System
Raleigh, NC1 day ago $70k - $85k
...Team Select Home Care in Raleigh, NC is seeking a Case Manager to oversee patient care and collaborate with healthcare providers. The role... ...RN with a minimum of one year of experience. Benefits include medical insurance, paid time off, and a competitive salary range of $7...Team Select Home Care
Raleigh, NC3 days ago- ...alternative application process. Care Manager 1 - Non-Clinical -Pender... ...individual, inclusive of medical, biopsychosocial, behavioral,... ...growth, health, and wellness Utilize Hospital/Data or Electronic Medical... ...community resources Knowledge of Case Management principles...Full timeCurrently hiringLocal areaRemote workWork from homeShift work
Community Care of North Carolina
Raleigh, NC4 days ago - ...health care to patients of all ages, utilizing standards of care and practice,... ...develop best practices for panel management. Collaborates with other teams to... ...development of the role of Case Management in the Patient Centered Medical Home (PCMH) and Advanced Medical...Local areaImmediate startFlexible hours
Cherokee Indian Hospital
Raleigh, NC1 day ago - Rockingham County, NC, is seeking a nurse for case management with a focus on pregnant women and children aged 0-5. Responsibilities include developing care plans, counseling families, and collaborating with community agencies. The ideal candidate will possess an Associate...
- PruittHealth is looking for a Hospice Registered Nurse (RN) Case Manager in North Carolina to join their team. This role involves providing hospice care in the patient’s home or care facility, ensuring high-quality assessments, documentation, and continuity of care. The...Flexible hours
$21.4 - $30.6 per hour
...support, and maintain accurate case documentation and... ...documentation discipline. Ability to manage time sensitive work,... .... Experience working with medical and pharmacy benefit payers and... ...Consistently demonstrates effective utilization and application of resources....Hourly payFull timeTemporary workWork experience placementLocal areaImmediate startRemote workMonday to FridayFlexible hoursShift workCardinal Health
Raleigh, NC3 days ago- PruittHealth is hiring a Registered Nurse Case Manager (RN) for their Hospice Services in Raleigh, North Carolina. The role involves completing assessments and ensuring continuity of patient care in hospice settings. The ideal candidate should possess an active RN license...
- Transitions LifeCare seeks to hire full-time Community-based Hospice RN Case Managers who provide compassionate, expert care to patients and families as they navigate end-of-life and serious illness. The role includes a $20,000 sign-on bonus for eligible experienced RNs...Full timeRelocation packageMonday to Friday
- Pruitthealth Corporation is seeking a Registered Nurse Case Manager (RN) for Hospice Services in Raleigh, North Carolina. In this on-call role, the RN will complete evaluations and maintain patient care in line with established protocols. Key qualifications include a current...
$82k - $85k
Amedisys in North Carolina is looking for a dedicated RN Hospice Case Manager. This role involves patient assessments and collaborating with the care team to deliver effective care. With a salary range of $82,000 to $85,000, this position offers a comprehensive benefits...$82k - $85k
Overview RN Hospice Case Manager Are you looking for a rewarding career in hospice? If so, we invite you to join our team at Amedisys, one... ...A full benefits package with choice of affordable PPO or HSA medical plans. Paid time off. Up to $1,000 in free healthcare...Monday to FridayShift work- ...dignity, comfort, and love. What You’ll Do as a Hospice RN / RN Case Manager: Be the primary point of contact for patients and families,... ...and families understand and navigate topics such as: Medication administration Hospice philosophy and services Symptom and...Daily paidFull timePart timeInternshipLocal area
- ...Hospice & Palliative Care is a 5 STAR rated non‑profit hospice offering compassionate end‑of‑life care support. As a Hospice RN Case Manager you will have flexibility in providing skilled complex care to the hospice patient and family in the community. The RN case...Full time
- PruittHealth is looking for a Hospice Registered Nurse (RN) Case Manager in Raleigh, North Carolina. The role focuses on providing comprehensive patient evaluations, maintaining care continuity, and completing necessary documentation in a timely manner. The ideal candidate...Relocation package
- Pruitthealth Corporation is seeking a Hospice Registered Nurse RN Case Manager in Raleigh, North Carolina. The role involves completing evaluations and maintaining continuity of care in a hospice setting. Candidates must hold an active RN license in North Carolina. The...
- ...with diverse clinical teams and utilize community resources to meet... ...individuals receiving care management services. Provide services in... ...and transition plans. Ensures medication monitoring and reconciliation... ...as a Care Manager, Case Manager, or Care Coordinator...Full timeLocal area
$99.7k - $166k
About the role The Senior Manager of Caselaw Content Expansion will... ...role reports to the Senior Director of Caselaw Enhancements. Responsibilities... ...Gen AI across the GEO Case Law organization. Identify... ...leaders. Experience in utilizing Legal Research and LLM console...Contract workLocal areaImmediate startWork from homeFlexible hours$92.6k - $127.4k
...reporting to the Branch Director of the Portland/Lake... ...company policy. Clinical Manager Develop, plans,... ...the location. Receive case referrals. Review available... ...recommendations by Utilization Review staff. Upon completion... ..., Humana provides medical, dental and vision...Full timeTemporary workApprenticeshipImmediate startRelocation packageCenterWell Home Health
Raleigh, NC1 day ago- A leading healthcare company is seeking a Medical Director to review inpatient medical claims and lead clinical decision-making without the... ...This role emphasizes the ability to analyze complex medical cases while collaborating with a team of physicians to ensure quality...Remote work
Humana
Raleigh, NC4 days ago $57.7k
...and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical... ...and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled...Temporary workFor contractorsWork at officeLocal areaRemote workHighmark Health
Raleigh, NC2 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medical Director, Utilization & Case Management. Be the first to apply!
Related searches
- public health project manager Raleigh, NC
- bcba clinical supervisor Raleigh, NC
- clinic supervisor Raleigh, NC
- clinical data manager remote Raleigh, NC
- medical device manager Raleigh, NC
- clinical research manager remote Raleigh, NC
- clinical account manager Raleigh, NC
- director sr. director clinical operations Raleigh, NC
- health services manager Raleigh, NC
- entry level healthcare project manager Raleigh, NC