- Elevance Health (Durham, NC)
- ** Nurse Appeals - Litigation & Legal Support**...entities, and serves as a subject matter expert for appeals , grievances, and quality of care issues. + ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management (UM) services to its clients, ensuring high- quality , clinically sound decision-making. The Clinical Appeal and Grievance ... Nurse is responsible for conducting daily clinical and benefit...for conducting daily clinical and benefit reviews in a quality -focused, production-driven environment. The position reports directly to the… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …participates in all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse ( RN ), Nurse Practitioner (NP), or ... decision maker and catalyst for achieving corporate goals through delivery of quality driven, clinically effective and cost-effective services. This role will be… more