- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including benefit interpretation, ... clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and benefit… more
- Elevance Health (Charlotte, NC)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... paralegal experience is strongly desired. + Understanding of the grievance and appeals process is strongly preferred....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CVS Health (Raleigh, NC)
- …and every day. **Position Summary** Plans and executes strategies to meet the Grievance & Appeals organization's long-range goals. Evaluates and develops new ... initiatives and analyzes business opportunities. Develops proposals, including feasibility studies, for new opportunities. Identifies, analyzes and compares alternative opportunities for solutions and adopting new technologies. + Acts as a top-level specialist… more
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