Top 14 Utilization review nurse Jobs in Winston Salem Nc

RN Case Manager Lead Wesley Long Hospital
Cone Health —Greensboro, NC
- Full-time
- Nursing
- RN License
- Hospital
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
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
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
Qualified Professional
Turning Point Relations —High Point, NC
- Part-time
- CPR Certification
- Addiction Medicine
- Experience working with individuals with disabilities
Quick Apply

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Clinical Sales Executive - Infusion
Amerita —Greensboro, NC
Current nursing license in assigned state required. Active RN license in assigned state. Valid driver’s license and auto insurance required.
$90,000 - $105,000 a year
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.

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
Quick Apply
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
10d

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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.

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Refine Your Search

utilization review nurse jobs in winston salem nc

RN Case Manager Lead Wesley Long Hospital

Medical Field Case Manager

Case Manager SE

Case Manager SE

RN Case Manager - Cardiothoracic Surgery

Home Health Clinical Manager

Qualified Professional

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