Top 30 Utilization management Jobs in Pembroke, Nc

Care Manager 1 - Non-Clinical -Robeson/Bladen County
Community Care of North Carolina Inc —Lumberton, NC
- Full-time
- Hybrid work
- Bilingual
- Nursing
- RN License
- Health savings account
- Disability insurance
Quick Apply
Licensed Mental Health Counselor
Lavni Inc —North Carolina
- From $50 an hour
- Part-time
- Remote
- Master of Social Work
- Microsoft Excel
- Psychiatry
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Qualified Professional
ACC Intermediate Care LLC. —Laurinburg, NC
- $19 - $25 an hour
- Part-time
- Addiction Medicine
- Experience working with individuals with disabilities
- Hospital
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Qualified Professional - Crisis Services
Southeastern Integrated Care LLC —Lumberton, NC
- On call
- Acute care
- Experience working with individuals with developmental disabilities
- Nursing
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13d
CMA/LPN
FirstHealth of the Carolinas, Inc. —Lumberton, NC
- Full-time
- Vital signs
- HIPAA
- Clinic
RNER Weekend Option
Scotland Health Care System —Laurinburg, NC
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Parental leave
RN PRN
Scotland Health Care System —Laurinburg, NC
- Part-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Parental leave
Senior Director Surgical Services
Scotland Health Care System —Laurinburg, NC
- Full-time
- Nursing
- Surgery
- RN License
- Paid parental leave
- Parental leave
Scotland Cancer Treatment Center Manager, RN
Scotland Memorial Hospital —Laurinburg, NC
- Full-time
- Nursing
- Management
- RN License
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Registered Nurse, Emergency Center
Scotland Health Care System —Laurinburg, NC
- Part-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Parental leave
Charge Nurse, Emergency Center
Scotland Health Care System —Laurinburg, NC
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Parental leave
Emergency Room Registered Nurse- Part Time
Scotland Health Care System —Laurinburg, NC
- Part-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Parental leave
Outpatient Therapist / Behavioral Health Licensed Clinical Professional
RHA Health Services, LLC —Lumberton, NC
- $48,000 - $60,000 a year
- Full-time
- Background check
- LMFT
- Pass drug screening
- Health insurance
- Paid time off
Quick Apply
3d
Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply

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Must maintain professional licensure and/or certification throughout employment with the clinic. Demonstrates appropriate use of diagnostic tools to describe…
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utilization management jobs near pembroke, nc

Care Manager 1 - Non-Clinical -Robeson/Bladen County

Community Care of North Carolina Inc -
Lumberton, NC

Quick Apply

Job Details

Full-time

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Vision insurance
Benefits from day one
Professional development assistance
Life insurance
Referral program

Qualifications

Nursing
Social work
Sociology
Driver's License
Bachelor's degree
Psychology
Human Services
Productivity software
Social Work
Psychology

Full Job Description

We're hiring Care Manager 1 - Non-Clinical across all 100 NC Counties - Must reside in NC or within 40 miles of NC border.

Currently hiring and must reside in the following NC counties: Robeson/Bladen County and neighboring counties

This is a field-based position with working remotely, when not providing integrated services to members directly. Occasional in-person training and travel will be required.

About CCNC:

From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high-quality care.

CCNC Mission Statement:

To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems.

Position Summary

Our new program, the Care Manager 1 - Non-Clinical, will provide statewide care management to support Medicaid enrolled members receiving adoption assistance. Care Managers address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required so they receive seamless, integrated, and coordinated health care to promote quality, cost-effective health outcomes.

Collaboration with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community is necessary to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager must reside in NC or within 40 miles of the NC Border.

What You'll Do:

Provide integrated whole-person Care Management under the new program Care Management model, including coordination across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care
Work with members and caregivers to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care
Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management
Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families
Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable
Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness
Utilize Hospital/Data or Electronic Medical Record system as available
Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies
Refer to appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and/or expertise
Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes
Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization
Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication
Respect the member’s values, experience, and help to empower members to be an advocate for their own care
Maintain appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures
Meet monthly productivity and role expectations
Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives
Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded
Perform all other duties as requested
Attend departmental and corporate meetings, local and regional trainings, or other events as required
Travel using personal vehicle will be required within the assigned area, region and/or the State

Qualifications:

Requires a Bachelor's Degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN
2 years of experience working directly with individuals served by the child welfare system is preferred
Must reside in NC or within forty (40) miles of the NC Border
CCM certification preferred
Maintain a valid driver’s license with current auto liability insurance

Knowledge, Skills, and Abilities:

Computer skills required including various office software and the internet, including experience with MS Office software.
Excellent communication skills – oral and written; Bilingual preferred
Knowledge of government, private sector, and community resources
Knowledge of Case Management principles
Knowledge of, and compliance with, federal and state regulations applicable to the position
Strong organizational and time management skills
Skills in establishing rapport with members and caregivers and applying techniques of assessing comprehensive health care needs
Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities
Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels
Ability to work independently and function as an integral part of a multi-disciplinary team
Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
Ability to shift strategy or approach in response to the demands of a situation
Ability to navigate Hospital/Data or Electronic Medical Record systems, as necessary

Working Conditions:

This is a field position. Care Manager will work remotely from home when not in the field
Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur
Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds
Travel will be required within the assigned area or region with occasional travel in other areas of the State

Why Join Us:

Make a meaningful impact on youth and families across North Carolina
Work with a supportive and collaborative care team
Competitive Benefits Package effective first day of employment
Opportunities for growth, training, and bonus incentives*

Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems?

Apply today and join us in delivering compassionate care that makes a difference.

Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems?

Apply today and join us in delivering compassionate care that makes a difference.

#CCNC #HealthCare #NCHealth

Benefits:

401(k)
Dental insurance
Disability insurance
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Professional development assistance
Referral program
Tuition reimbursement
Vision insurance

Work Location: Hybrid remote in Lumberton, NC 28358

Quick Apply

Refine Your Search

utilization management jobs in pembroke, nc

Care Manager 1 - Non-Clinical -Robeson/Bladen County

Licensed Mental Health Counselor

Qualified Professional

Qualified Professional - Crisis Services

CMA/LPN

RNER Weekend Option

RN PRN

Senior Director Surgical Services

Scotland Cancer Treatment Center Manager, RN

Registered Nurse, Emergency Center

Charge Nurse, Emergency Center

Emergency Room Registered Nurse- Part Time

Outpatient Therapist / Behavioral Health Licensed Clinical Professional

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)