- Cognizant (Raleigh, NC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Organizations (IROs) for timely and accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and ... About The Role BHPS provides Utilization Management (UM) services to its...including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …for the Casualty and Clinical Services departments which in turn includes Utilization Management , Case Management and Population Health divisions. ... + Strong skills in management of a clinical team. + Previous Utilization Management experience required. + Previous experience in Case Management … more