- Humana (Topeka, KS)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and… more
- Molina Healthcare (Columbus, OH)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Supervises staff responsible for the… more
- Motion Recruitment Partners (Birmingham, AL)
- …and passionate about making a difference in healthcare? We are seeking several Appeals and Grievances Coordinators for an onsite contract opportunity in ... communication skills will help drive impactful results as you navigate complex appeals and grievances processes. The ideal candidate will demonstrate initiative,… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for...assigning all incoming appeals and grievances… more
- Cedars-Sinai (CA)
- …processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins ... management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred +… more