Top 32 Utilization review Jobs in Winston Salem Nc

RN Case Manager Lead Wesley Long Hospital
Cone Health —Greensboro, NC
- Full-time
- Nursing
- RN License
- Hospital
Licensed Mental Health Counselor
Lavni Inc —North Carolina
- From $50 an hour
- Part-time
- Remote
- Master of Social Work
- Microsoft Excel
- Psychiatry
Quick Apply
Licensed Mental Health Counselor
Lavni Inc —North Carolina
- From $50 an hour
- Part-time
- Remote
- Master of Social Work
- Microsoft Excel
- Psychiatry
Quick Apply
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
Complex Inpatient Medical Social Worker
Atrium Health —Winston-Salem, NC
- $33.05 - $49.60 an hour
- Full-time
- Master of Social Work
- Inpatient
- Mid-level
- Paid parental leave
- Disability insurance
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
Case Manager SE
Advocate Aurora Health —Winston-Salem, NC
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- RN License
- Hospital
Qualified Professional PSR
SPRING LIFE BEHAVIORAL CARE LLC —Winston-Salem, NC
- $15 - $30 an hour
- Mid-level
- Office
- Master's degree
Qualified Professional
Turning Point Relations —High Point, NC
- Part-time
- CPR Certification
- Addiction Medicine
- Experience working with individuals with disabilities
Quick Apply
14d
Qualified Professional
J4 Stability & Safe Haven —Winston-Salem, NC
- $20 - $30 an hour
- Weekends as needed
- Management
- Mid-level
- Office
Quick Apply
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
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
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
Licensed Clinical Addictions Specialist (LCAS)
Pyramid Healthcare —Winston-Salem, NC
- $48,000 - $55,000 a year
- Full-time
- Addiction Medicine
- Mid-level
- Residential
- Paid holidays
- Health insurance
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Regional Director of Utilization Management
ADDICTION AND MENTAL HEALTH SERVICES, LLC —United States
- $115,000 - $130,000 a year
- Full-time
- Nursing
- 3 years
- Master's degree
- Loan repayment program
- Health insurance
12d
Behavioral Health Leadership & Clinical Contract / Interim Engagements
SimiTree Talent Solutions —United States
- Full-time
- Psychiatry
- Addiction Medicine
- Senior level
- Travel reimbursement
Quick Apply

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Clinical Document Integrity Specialist - Part Time - Remote
Duke Health —Mooresville, NC
Currently licensed and/or registered as a Professional Nurse/Physician Assistant/MD in the state of North Carolina, preferred. CCDS, CCS, or CDIP preferred.
Assistant Clinical Director (BCBA)
Bright Achievements —Greensboro, NC
Active state licensure where applicable. Master's degree or higher in Applied Behavior Analysis, Psychology, Education, or a related field.
$90,000 - $100,000 a year
Quick Apply

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
10d
Appeals Nurse Consultant (Remote)
CVS Health —Columbus, OH
Must have active and unrestricted RN licensure in state of residence. Qualified applicants with arrest or conviction records will be considered for employment…
$60,522 - $129,615 a year
4d

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RN Case Manager Lead Wesley Long Hospital

Cone Health -
Greensboro, NC

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Job Details

Full-time

Qualifications

Inpatient experience
RN License
BLS Certification
Managing patients as a nurse case manager
Hospital experience

Full Job Description

The RN Care Management Lead is an advanced-level member of the Case Management team responsible for coordinating care for patients with significant medical and psychosocial needs, high risk for re-admission and/or prolonged hospitalizations. The Lead in collaboration with the Care Management staff will provide targeted support for the hospital's more complex cases and will lead system-level coordination through Complex Case Rounds (Quality Collaborative). The team will act as a bridge between inpatient care and other ambulatory or service-based teams to ensure continuity and prevent avoidable readmissions for the highest-risk patients.

Essential Job Function:
Assessment & Identification Identify patients across the hospital with extended Lengths of Stay and assess Complex Care Needs that may require significant time and coordination from unit Case Management staff.
Work with Cone’s EPIC predictive analytics to identify and manage potential complex patients or those with a predictive difficult to place flag Care Planning Develop and implement comprehensive, patient-centered discharge plans using advanced clinical judgment and creative problem-solving to promote continuity of care and appropriate resource utilization.
Collaboration and Coordination May Co-Lead and facilitate inpatient interdisciplinary Complex Case Rounds (Quality Collaborative), engaging senior level leadership to identify, escalate and resolve barriers to discharge.
Engage with known complex case patients in the ED, by collaborating with ED providers, social workers and case management, to identify alternative care placements that will support optimal outcomes.
Collaborate with ambulatory and community-based teams to ensure seamless transitions, prevent readmissions and secure post-discharge follow-up to ensure successful transition to the next level of care.
Build and maintain strong relationships with post-acute service providers, insurance case managers, primary care provider case managers, and VBC Initiatives to ensure coordinated value-based care delivery.
Collaborate with Cone’s UR / UM division to ensure both patient choice and aligned post-acute partners to ensure appropriate next level of care is optimized Resource Utilization and Advocacy Assist in preparing a cost-benefit analysis for medically and socially complex Long LOS patients and advocate for necessary resources to support discharge.
Educate patients and families about viable care options, post-discharge needs and community resources to support continuity of care.
Monitoring Monitor “avoidable days” and “avoidable delays” within case load to identify system barriers and uncover opportunities for process improvement across hospital operations and community partnerships.
Responsible for the following: New hire orientation, departmental training, subject matter expert and resources for other team members, participate in interviews, on call, make coverage assignments, safety zone resolution, and representation of department for strategic hospital meetings.

Education:
Required: BSN or MSN from an accredited school of nursing.

Experience:
Required: 5 years inpatient case management experience.
Preferred: Experience in people management. ACM-RN or CCM certified with 3 years of inpatient case management experience.

Licensure/Certification/Listing:
Required: Must hold an active, unencumbered NC Nursing License. Current BLS. Willingness to participate and maintain active engagement in Cone’s clinical ladder program.

Apply Now

Refine Your Search

utilization review jobs in winston salem nc

RN Case Manager Lead Wesley Long Hospital

Licensed Mental Health Counselor

Licensed Mental Health Counselor

Medical Field Case Manager

Complex Inpatient Medical Social Worker

Case Manager SE

Case Manager SE

Qualified Professional PSR

Qualified Professional

Qualified Professional

Inpatient RN Care Manager Lead

Home Health Clinical Manager

RN Case Manager - Cardiothoracic Surgery

Licensed Clinical Addictions Specialist (LCAS)

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Regional Director of Utilization Management

Behavioral Health Leadership & Clinical Contract / Interim Engagements

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