- Humana (Boston, MA)
- …Medical Director relies on medical background and reviews 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 about the appropriateness of… more
- Humana (Boston, MA)
- …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
- Commonwealth Care Alliance (Boston, MA)
- …5+ years of clinical nursing experience is strongly preferred. + Experience in Medicaid/ Medicare grievances and appeals and/or Utilization Review is strongly ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate...compliance with state and federal guidelines, including Centers for Medicare and Medicaid Services requirements. Maintain all appeals… more
- Point32Health (Canton, MA)
- …including but not limited to P&T, DCC, MAD, Management team meetings, Appeals & Grievances , Quality Performance Improvement Team (QPIT). + Direct ... to meet regulatory and accreditation requirements and to meet Point32Health's corporate priorities. The Senior Clinical Pharmacist also oversees the structure and… more