Top 44 Utilization management nurse Jobs in Winston Salem Nc

Physical Health Registered Nurse (Remote)
Vaya Health —North Carolina
- $68,033.34 - $88,443.35 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
Home Health Registered Nurse
Condustrial Inc —North Carolina
- $75 - $80 an hour
- Part-time
- Background check
- Nursing
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Care Manager (Chatham County, NC)
Vaya Health —North Carolina
- $54,007.07 - $70,209.18 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Case Manager SE
Advocate Aurora Health —Winston-Salem, NC
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- RN License
- Hospital
Case Manager SE
Atrium Health —Winston-Salem, NC
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Disability insurance
RN Case Manager - Cardiothoracic Surgery
Atrium Health —Winston-Salem, NC
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- Surgery
- RN License
- Paid parental leave
- Disability insurance
8d
Clinical Coordinator
Novant Health —Winston-Salem, NC
- 8 hour shift
- Nursing
- RN License
- Bachelor of Science
Care Management Nurse Consultant, RN (Hickory/Forest City, NC)
Partners Behavioral Health Management —Winston-Salem, NC
- Full-time
- Spanish
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
4d
Home Health Clinical Manager
Centerwell —Winston-Salem, NC
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
5d
Inpatient RN Care Manager Lead
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Disability insurance
8d
Ambulatory Assistant Nurse Manager - Pediatrics
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Disability insurance
10d
Medical Field Case Manager
Enlyte —Winston-Salem, NC
- $70,600 - $85,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
Assistant Ambulatory Nurse Manager (OR)-Surgery Center
Atrium Health —High Point, NC
- $41.10 - $61.65 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Paid parental leave
- Disability insurance
Part time Charge Nurse
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- 12 hour shift
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Disability insurance
RN Supervisor - Work and Campus Care
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
- Paid parental leave
- Disability insurance
Home Care Clinical Manager (RN)
Avid Health at Home —High Point, NC
- Weekends as needed
- Bilingual
- Nursing
- RN License
Quick Apply
Care Manager - LP (Cherokee County, NC)
Vaya Health —North Carolina
- $62,993.84 - $75,000.00 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
Care Manager (Alamance County, NC)
Vaya Health —North Carolina
- $54,007.07 - $70,209.18 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Registered Nurse - (Charge RN) Interventional Cardiology
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Charge Nurse - General Medicine - Weekends
Atrium Health —Winston-Salem, NC
- $41.10 - $61.65 an hour
- 12 hour shift
- CPR Certification
- Nursing
- Surgery
- Paid parental leave
- Disability insurance

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utilization management nurse jobs near winston salem nc

Physical Health Registered Nurse (Remote)

Vaya Health -
North Carolina

Apply Now

Job Details

Full-time
$68,033.34 - $88,443.35 a year

Qualifications

Computer operation
Nursing
Managed care organization experience
Computer literacy
Coaching
Patient management software
Acute care facility experience
EMR/EHR
Utilization management
Conflict management
Mentoring
Resource utilization in healthcare
Productivity software
Benchmarking
Associate's degree
Associate Degree in Nursing
Healthcare data reporting
Nursing

Full Job Description

LOCATION: Remote – this a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

The Physical Health Registered Nurse is responsible for completing clinical reviews for appropriateness, medical necessity, and quality. The Physical Health Registered Nurse applies standardized clinical review criteria to determine medical necessity for service authorization requests. The Physical Health Registered Nurse refers service authorization requests to an appropriate physician peer reviewer when medical necessity criteria are not clearly met. Reviews performed by the individual in this position may be pre-service, concurrent, or retrospective in nature. This position is part of a team of nurses, physicians, psychologists, pharmacists and non-clinical associates who work closely to care for our members.

The day-to-day operations of the Physical Health Utilization Management Department require coverage on weekends and holidays. The incumbent in this position will be required to participate in a rotation to ensure coverage every day including weekends and holidays. The amount of work on scheduled weekends and holidays will be subject to change.

ESSENTIAL JOB FUNCTIONS

Process requests for authorization of services:

Responsible for reviewing requests for authorization of services including inpatient hospital admissions, re-admissions, inpatient rehabilitation services, skilled nursing admissions, home care /home infusion services, outpatient and/or inpatient services as designated.
Documents timely decisions and actions taken within the managed care information system (MCIS).
Meets contractual timelines for completion of review activities
Communicates and interacts with providers as well as internal and external partners to facilitate and coordinate the activities of the UM process.
Utilizes technology (computer-based systems) and resources to support work activities appropriately.
Communicates determinations to providers per established business process

Supporting UM Functions:

Actively participates in all required staff meetings and complex case rounds
Perform discharge planning to achieve safe and timely enrollee discharges from hospitals and facilities
Successfully completes Inter-rater Reliability (IRR) training, exams, and testing with at least an 80% passing rate or above thresholds established by management
Follows all UM workflow processes

All other duties as assigned in support of UM functions.

KNOWLEDGE, SKILLS, & ABILITIES

This position requires a high degree of autonomy, professional relationships and organizational skills. Applicants with thorough knowledge of the following are prioritized:

Primary care, behavioral health and healthcare system in NC;
Vaya Health Provider Network;
Medical practice workflows;
Vaya contracts with the NC Department of Heath and Human Services (NCDHHS) and other contracts for which Vaya is responsible;
Vaya organizational purpose/role per federal and state statute, strategic plan, leadership and departmental roles, relationships and scope;
Federal and state confidentiality requirements;
Member and staff health & safety requirements;
Corporate compliance requirements;
Vaya Policies and Procedures;
Project management principles.

Additional required skills and abilities include but are not limited to the following:

Clear, concise and appropriate verbal, written and electronic communication;
Ability to present in large group settings;
Ability to adapt to rapid changes;
Effectively implement new initiatives;
Computer literacy and familiarity with Microsoft Office software as well as Vaya's Administrative Health Record and/or Care Management Platform, Vaya’s Member Services and UM Platform.
Strong conceptual skills, with knowledge and skill in problem-solving, decision-making, conflict resolutions, and critical thinking.
Ability to mentor, coach and facilitate change and innovation.
Ability to develop reporting mechanisms that will produce data needed to support and benchmark quality initiatives.

PHYSICAL REQUIREMENTS

Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
Mental concentration is required in all aspects of work.

EDUCATION & EXPERIENCE REQUIREMENTS

Associate Degree in Nursing required. Bachelor’s Degree in Nursing preferred.

Five (5) years of clinical experience preferably across the continuum of care with at least two years of acute care experience.
Experience performing utilization management functions in a managed care setting.
Proficient at using software programs such as Microsoft Office tools.

Licensure/Certification Required:

Active and unrestricted RN License in the State of North Carolina or Nurse Licensure Compact (NLC) license.

RESIDENCY REQUIREMENTS: The person in this position must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.

Apply Now

Refine Your Search

utilization management nurse jobs in winston salem nc

Physical Health Registered Nurse (Remote)

Home Health Registered Nurse

Care Manager (Chatham County, NC)

Case Manager SE

Case Manager SE

RN Case Manager - Cardiothoracic Surgery

Clinical Coordinator

Care Management Nurse Consultant, RN (Hickory/Forest City, NC)

Home Health Clinical Manager

Inpatient RN Care Manager Lead

Ambulatory Assistant Nurse Manager - Pediatrics

Medical Field Case Manager

Assistant Ambulatory Nurse Manager (OR)-Surgery Center

Part time Charge Nurse

RN Supervisor - Work and Campus Care

Home Care Clinical Manager (RN)

Care Manager - LP (Cherokee County, NC)

Care Manager (Alamance County, NC)

Registered Nurse - (Charge RN) Interventional Cardiology

Charge Nurse - General Medicine - Weekends

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