Top 25 Clinical documentation & utilization review nurses Jobs in Cary, Nc

Clinical Quality Analyst (Full-time Remote, North Carolina Based)
Alliance Health —Morrisville, NC
- $79,425 - $101,267 a year
- Full-time
- Remote
- LMFT
- Nursing
- RN License
- Disability insurance
- Health insurance
Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC
Sentara Health Administration, Inc. —Raleigh, NC
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- 403(b) matching
- Paid parental leave
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Raleigh, NC
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Regional MDS Manager
SHCM Corporate —Raleigh, NC
- Nursing
- RN License
- 3 years
- Travel reimbursement
- 401(k)
Quick Apply
MDS Coordinator- RN
Sunnybrook Rehabilitation Center —Raleigh, NC
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Health insurance
Quick Apply
Clinical Quality Assurance Specialist - Bone Marrow Transplant Program
UNC Health —Chapel Hill, NC
- $35.87 - $51.57 an hour
- Full-time
- Hybrid work
- Nursing
- RN License
- Mid-level
Utilization Manager
Duke Health —Durham, NC
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Relocation assistance
5d
Clinical Documentation Specialist
Singing River Health System —Raleigh, NC
- Weekends as needed
- Remote
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
Clinical Assessor, - RN (Hybrid/Travel) Wake County, NC
Acentra Health, LLC —Raleigh, NC
- $67,300 - $93,050 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- RN License
- Computer literacy
- Health insurance
- Tuition reimbursement
CHARGE CODE AUDITOR
Duke Health —Durham, NC
- 8 hour shift
- Nursing
- RN License
- BLS Certification
- Relocation assistance
MDS Coordinator
PruittHealth —Raleigh, NC
- Full-time
- Background check
- RN License
- Mid-level
- Paid orientation
- Referral program
MDS Assistant LPN/RN (PRN) - Skilled Health Care Center
Croasdaile Village Retirement Community —Durham, NC
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- 403(b) matching
- AD&D insurance
MDS Coordinator (RN or LPN)
Highfield Nursing and Rehabilitation —Cary, NC
- $34 - $37 an hour
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Paid holidays
- Dental insurance
Quick Apply
3d
Resource / Travel MDS Coordinator (RN/LPN)
Signature HealthCARE of Chapel Hill —Chapel Hill, NC
- 8 hour shift
- Skilled nursing facility
- Float pool
- RN License
- Health savings account
- Paid holidays
3d
Mobile MDS (RN)
Saber Community Support and Development Office —Raleigh, NC
- Full-time
- RN License
- Mid-level
- Travel
- Health savings account
- Paid holidays
Quick Apply
MDS RN
Hartwell Health & Rehab Center —Garner, NC
- Full-time
- CPR Certification
- Skilled nursing facility
- RN License
- Health savings account
- Health insurance
Quick Apply
ResCarSpec DirRN - MDS Coordinator
Treyburn Rehabilitation Center —Durham, NC
- $39.00 - $41.50 an hour
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Health insurance
Quick Apply
12h

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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…
RN MDS Nurse
Aventura at Oakwood Village —Springfield, OH
Current, active Registered Nurse (RN) license. Ensure timely and accurate completion of all MDS assessments in accordance with federal and state regulations.
Quick Apply

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clinical documentation & utilization review nurses jobs near cary, nc

Clinical Quality Analyst (Full-time Remote, North Carolina Based)

Alliance Health -
Morrisville, NC

Apply Now

Job Details

Full-time
$79,425 - $101,267 a year

Benefits

Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
Flexible schedule
Retirement plan

Qualifications

Patients with traumatic brain injuries
Clinical case management
Care plan development
Negotiation

Full Job Description

The Clinical Quality Analyst manages the quality review process for care management programs. Incumbents conduct quality reviews of internal data and processes to identify trends/patterns that impact service/system quality and may require interventions.

This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.

Responsibilities & Duties

Analyze Care Management documentation and activities to ensure compliance

Review the quality-of-Care Management internal processes/plans and provider information, such as Person-Centered Plans or chart notes, for alignment with procedures and/or best practices
Audit Care Management clinical documentation, case interventions, and, if available, staff phone recordings to ensure alignment with program descriptions, workflows, internal policies, evidence based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines (when applicable)
Identify and escalate situations which may pose quality, compliance, and safety risks that may adversely affect business operation
Evaluate clinical appropriateness of decisions, recommendations, and actions within Care Management documentation
Interpret qualitative and quantitative information to appropriately document findings
Make recommendations for improvement related to any records reviewed and write reports of findings
Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations

Analyze Data and Report on findings

Generate monthly Care Management Quality reports on Staff performance to submit to Directors, Managers, and Supervisors
Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommended

Evaluate knowledge gaps of staff and coordinate training

Evaluate knowledge gaps of the staff and collaborate with Care Management Leadership to coordinate learning and training opportunities with the Care Management Training team
Monitor training of staff for effectiveness and impact of outcomes from enhanced training

Minimum Requirements

Graduation from an accredited school of Nursing with a Registered Nurse (RN) license and three (3) years of experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

Master’s degree in Health, Psychology, Sociology, Social Work, or another relevant Human Services field from an accredited college/university with a North Carolina Clinical license (LCSW, LCMHC, LMFT, LPA) and three (3) years of experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

Required experience

Experience with Care plans, comprehensive assessments, care management interventions, and service engagement activities
Medicaid Managed Care
Integrated care (behavioral and physical health)

Preferred Experience

Auditing Clinical documentation

Preferred Certification-

Certified Care Manager (CCM)

Special Requirement

Current, active, unrestricted NC clinical license such as RN, LCSW, LMHC, or LMFT to practice as a health professional within the scope of licensure in the state of North Carolina.

Knowledge, Skills, & Abilities

Knowledge of North Carolina State and Federal rules and requirements related to the service continuum in North Carolina
Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
Knowledge of best and promising practices for behavioral & physical health and/or intellectual/developmental disabilities
Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool)
Strong clinical skills
Problem solving skills
Interpersonal Skills
Strong Analytical skills
Problem solving and conflict resolution skills
Strong diplomacy skills and discretion
Highly effective communication skills
Ability to negotiate and resolve issues with minimal assistance

Salary Range

$79,425 - $101,267/ Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility

Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: https://youtu.be/1GZOBFx61QU (https://youtu.be/1GZOBFx61QU)

Education

Preferred

Nursing or better in Nursing
Masters or better in Human Services

Licenses & Certifications

Preferred

Lic Clinical MH Counselor
Lic Clinical Social Wkr
Lic Marr & Family Ther
Lic Psychological Assoc
Registered Nurse

Skills

Required

Analysis
Diplomacy
Microsoft Office

Preferred

Problem Solving

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in cary, nc

Clinical Quality Analyst (Full-time Remote, North Carolina Based)

Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC

Senior Consultant - Clinical Documentation Specialist

Regional MDS Manager

MDS Coordinator- RN

Clinical Quality Assurance Specialist - Bone Marrow Transplant Program

Utilization Manager

Clinical Documentation Specialist

Clinical Assessor, - RN (Hybrid/Travel) Wake County, NC

CHARGE CODE AUDITOR

MDS Coordinator

MDS Assistant LPN/RN (PRN) - Skilled Health Care Center

MDS Coordinator (RN or LPN)

Resource / Travel MDS Coordinator (RN/LPN)

Mobile MDS (RN)

MDS RN

ResCarSpec DirRN - MDS Coordinator

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