- Molina Healthcare (Austin, TX)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- Guardian Life (Austin, TX)
- The ** Texas State Dental Director ** will be responsible for ensuring that professional DHMO activities in the State of Texas are compliant with applicable ... state regulations. You will ensure that claims, referrals, appeals , and grievances meet state specific regulations,...report any quality-of-care issues. In addition, the State Dental Director will be expected to lend support to the… more
- Molina Healthcare (Austin, TX)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more