- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- UNC Health Care (Hendersonville, NC)
- …including requests, follow-ups, tracking of approvals and denials, and completing appeals . Oversees/maintains the denial and RAC request/response data bases; ensures ... of records and outcomes. Works with EHR to file appeals and coordinate the follow up with EHR. Coordinates...* Must be licensed to practice as a Registered Nurse in the state of North Carolina or one… more
- Sharecare (Raleigh, NC)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- CaroMont Health (Gastonia, NC)
- …healthcare with the best clinical outcomes possible. Provide physician and nurse education to achieve compliance with best practice and evidence-based guidelines. ... departments and committees. Assist with retrospective reviews and preparation of appeals as indicated. Facilitate peer review activities and integrate review… more