- Sanford Health (Sioux Falls, SD)
- …or regulatory review functions. Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Elevance Health (Morristown, NJ)
- **Plan Performance Medical Director - New York Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required ... Medical Director ** serves as the Chief Medical Officer for the health plan's Commercial ...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- CVS Health (Springfield, IL)
- …portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...(Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will… more
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations,… more
- Humana (Little Rock, AR)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- CVS Health (Austin, TX)
- …of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Elevance Health (Denver, CO)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. Schedule: Fulltime position, Monday through Friday. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- Sharp HealthCare (San Diego, CA)
- …system reports and utilizes monitoring tools to track the trending of both Commercial and Government Payer Denials and Appeals . Serves as managing leader ... and hiring teams. **What You Will Do** The System Director of Revenue Cycle, Quality, and Audit is responsible...Verification, Record Coding Audits, Denials Management, Payer and Regulatory Appeals , and Chargemaster). Is accountable to work in a… more
- Robert Half Finance & Accounting (Carlisle, PA)
- Description We are looking for a dedicated Revenue Cycle Management Director to lead and manage all aspects of our client's revenue cycle operations. This position ... * Oversee the revenue cycle processes for Medicaid, Medicare, managed care, commercial payers, and sliding fee programs. * Establish and enforce billing policies… more
- AmeriHealth Caritas (Washington, DC)
- **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the Market President, with oversight of operation services delivered by the ;Healthy DC ... Plan and all relevant federal, state, and local regulatory requirements. The Director Operations Healthy DC Plan is accountable for ensuring the plan's operating… more
- Access: Supports For Living (Middletown, NY)
- Revenue Cycle Director Location: Middletown, NY, United StatesDate Posted: Nov 14, 2025 Share: share to e-mail Apply Now Save JobSaved Description ... New York State, particularly regarding Medicare, Medicaid, Medicaid Managed Care, and Commercial Insurance. Key Responsibilities + Lead and supervise a billing team… more
- State of Colorado (CO)
- …+ Accounting Services led by the Controller + Budget and Policy led by the Budget Director + Procurement and Commercial Cards led by the Purchasing Director ... a wide range of benefits to our employees. + Medical and dental options are available for permanent employees...knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street,… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- State of Colorado (Lakewood, CO)
- …of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, ... RAA-EDO-15422-Acct II-11/25 Department Department of Public Safety Division Executive Director 's Office Opening Date 11/21/2025 Closing Date 12/15/2025 5:00 PM… more
- State of Colorado (Golden, CO)
- …of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, ... EDO 00084 Plumber 08/2025 Department Department of Public Safety Division Executive Director 's Office Opening Date 11/19/2025 Closing Date 12/2/2025 5:00 PM Mountain… more
- State of Colorado (Craig, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... public? Do you have a Class A or B Commercial Driver's License? If so, come join CDOT as...keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance,… more
- R1 RCM (Boise, ID)
- …transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise ... Consultant, you will represent and counsel healthcare providers in their disputes with medical insurance carriers and managed care organizations at all stages of the… more
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