- Cognizant (Raleigh, NC)
- …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Brighton Health Plan Solutions, LLC (NC)
- …and accreditation requirements. * Duties as assigned. Essential Qualifications * Current Registered Nurse (RN) with state licensure. Must retain active and ... care. * Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. *...within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …in all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse (RN), Nurse Practitioner (NP), or Physician Assistant ... Clinical Services (CS) functions (prior authorization, concurrent review, appeals , case management, disease management, population health) per defined Client… more