- Elevance Health (Durham, NC)
- ** Nurse Appeals RN - Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and...and summarizes medical information for medical director. + Prepares nurse summaries for Quality of Care cases… more
- Evolent (Raleigh, NC)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of… 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