- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… 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