Clinical Appeal and Grievance Nurse - Chapel Hill

Brighton Health Plan Solutions is looking for a part-time board-certified physician to support its team with medical necessity and benefit coverage determinations. · Provides clinical support for all areas of Medical Affairs. · Makes coverage and medical necessity determinations ...

Brighton Health Plan Solutions busca a un médico director part-time para apoyar su equipo de enfermeras, trabajadores sociales y coordinadores. Se requiere experiencia en gestión de utilización y caso manejado. · ...

The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, · Primary Responsibilities:Performs clinical utilization reviews using evidenced based guidelines,policies and nationally recognized clinical criteria an ...

+The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working remotely. · Performs clinical utilization reviews using evidenced based guidelin ...

· About The Role · Brighton Health Plan Solutions, a full-service health plan administrator, is looking for a part-time board-certified physician with interest and experience in managed care utilization and case management to support our team of nurses, social workers, and coord ...

Brighton Health Plan Solutions is looking for a part-time board-certified physician with interest and experience in managed care utilization and case management to support our team of nurses, social workers, and coordinators. You will be a leader of the team making medical necess ...

Brighton Health Plan Solutions is looking for a part-time board-certified physician to support our team in managed care utilization and case management. · ...

About The Role · BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working re ...

About The Role · BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working re ...

Community Name: · Chapel Hill CommunityThe Director of Dining Services is responsible for organizing, planning, directing, controlling and supervising functions and personnel within the dining services department to ensure the provision of quality food service and nutritional car ...

Mental health qualified professionals are responsible for planning and coordinating services for consumers with mental health and development disabilities. They integrate multiple services from different providers and agencies based on individual needs. · ...

We are seeking experienced clinical professionals to join a high-performing Appeals Department supporting Medicare and Commercial lines of business.This role plays a critical part in ensuring timely, compliant, and clinically sound appeal determinations while collaborating closel ...

Volunteers of America National Services (VOANS) Healthcare is seeking a Regional Quality Manager to lead quality improvement efforts across an assigned region. · ...

Purpose of Your Job Position · The primary purpose of your position is to provide direct nursing care to the residents, and to supervise the day-to-day nursing activities performed by CNAs/GNAs and other nursing personnel. To monitor the performance of CNAs/GNAs, nursing and non- ...

Volunteers of America National Services (VOANS) Healthcare is seeking a Regional Quality Manager (RQM) to lead quality improvement efforts across an assigned region. · ...

Volunteers of America National Services (VOANS) Healthcare seeks a Regional Quality Manager to lead quality improvement efforts across an assigned region. · A bachelor's degree in a healthcare-related field is required. · Certified Professional in Healthcare Quality (CPHQ) or oth ...

THE FOREST AT DUKE · JOB DESCRIPTION · POSITION: Staffing Coordinator DEPARTMENT: Health Services · SUPERVISOR: Home Care Administrative Manager DATE: December 2025 · General Purpose: · Ensure appropriate staffing levels for The Forest at Home case load. · Qualifications: · High ...

+Job summary · Telecounselors provides individual counseling services via a HIPAA compliant, synchronous video platform to patients within New Season's clinics across the United States. · +Qualifications · Candidates hold current independent counseling license (LMHC, LCSW, LMFT o ...

Community Name: · Chapel Hill CommunityThe Director of Dining Services is responsible for organizing, planning, directing, controlling and supervising functions and personnel within the dining services department to ensure the provision of quality food service and nutritional car ...

The primary purpose of the Licensed Practical Nurse position is to provide direct nursing care to residents and supervise day-to-day nursing activities performed by CNAs/GNAs and other nursing personnel. · ...