- Humana (Providence, RI)
- …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 (Providence, RI)
- …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
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… 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