- Humana (Raleigh, NC)
- …in the form of objectives and determines approach, resources, schedules and goals. The ** Grievance and Appeals Manager ** is dedicated to delivering service ... and effectiveness of the Medicare and Medicaid G&A processes. The Grievance and Appeals Manager possesses strong leadership skills, in-depth knowledge of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...active and unrestricted licensure throughout employment. + Understanding of Appeals guidelines as applicable with URAC, NCQA, and ERISA.… more