- Point32Health (Canton, MA)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management ... and oversight of the Enterprise Member Appeals and Grievances Department. The Director is responsible for all aspects of the member appeals and grievance… more
- Humana (Boston, MA)
- … 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 services… more
- University of Massachusetts Amherst (Amherst, MA)
- Director of Human Resources (Facilities & Campus Services) Apply now ... adds to the intellectual energy of the region. Job Summary As the Director of Human Resources Facilities & Campus Services (F&CS) Service Center, manages effective… more
- Commonwealth Care Alliance (Boston, MA)
- …or more core operational functions, including call centers, enrollment functions, and appeals / grievances . Knowledge, Skills & Abilities Required: + Knowledge of ... and providers. Supervision Exercised: Yes. Direct Reports Include the Director of Member Service, Director of Provider Service, Senior Director of Member… more
- Beth Israel Lahey Health (Westwood, MA)
- …address information. Escalates calls to pharmacists for clinical inquiries and escalates grievances to supervisor. 7. Maintains new and existing patient profiles and ... Support health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing problems/issues with… more