- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Providence, RI)
- …first** The Resolution team handles all complaints for Humana, including formal grievances , appeals, inquiries and disputes. Our mission is to resolve these ... associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will...starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +… more
- Fallon Health (Worcester, MA)
- …is responsible for the presentation of the member appeal to the FH Medical Director , Center for Medicare /Medicaid Services, contracted reviewer, as ... staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures… more
- Point32Health (Canton, MA)
- …and trend to aid in managing pharmacy costs. + Collaborate with the Pharmacy Medical Director and Marketing to develop member and provider specific communication ... (P&T) Committee and Drug Coverage Committee (DCC), participates in medical policy formulation and interpretation, and provides information/training to new… more