- AmeriHealth Caritas (Newark, DE)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Appeals & Grievances Location: Los Angeles, CA,...This position will work with department Supervisors, Managers and Director for all problems related to quality improvements as… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the...staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in… more
- Humana (Topeka, KS)
- …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
- Humana (Honolulu, HI)
- … 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
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... This position is 100% Remote . We are hiring for the following schedules...each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case… more
- UPMC (Pittsburgh, PA)
- …or Emergency Medicine Physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This role is ... choose their weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Molina Healthcare (Scottsdale, AZ)
- …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the...Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify ... business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp...trends in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical...in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Insight Global (Norfolk, VA)
- Job Description Insight Global is looking for a Remote Director of Health Plan Business Testing for a large healthcare company. This individual must reside in ... one of the approved remote states listed below. This candidate will lead all...Claims, Encounters, Benefits Configuration, Claims & Pricing Configuration, Enrollment, Appeals & Grievances , and Contact Center/Customer Service.… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …clinical teams + Strong background in quality improvement, utilization management, appeals and grievances , and clinical operations + Insurance industry ... leader to join our team as Lead Medical Review Director -a pivotal role with a clear path toward Chief...scale\.** **What You'll Do:** + Lead medical necessity reviews, appeals , and peer\-to\-peer consultations + Supervise and mentor a… more
- Oregon State University (Corvallis, OR)
- …Administrator 2-Contr & Compl Job Title Assistant Dean of Students and Director of Disability Access Services Appointment Type Professional Faculty Job Location ... Corvallis Benefits Eligible Full-Time, benefits eligible Remote or Hybrid option? Job Summary Disability Access Services...Services is seeking an Assistant Dean of Students and Director of Disability Access Services. This is a full-time… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver,… more
- Humana (Springfield, IL)
- …Manager, and Medical Director ) and departments to address and resolve member grievances and appeals . + Oversees the interface with the Enrollment Broker ... referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures + In close...+ **Direct Reports:** Up to five associates. + **Workstyle: Remote - work at home** ; must live in… more
- State of Colorado (Pueblo, CO)
- …appeal with the State Personnel Board or request a review by the State Personnel Director . You will find the appeals process, the official appeal form, and how ... Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes,… more
- State of Colorado (Pueblo, CO)
- …appeal with the State Personnel Board or request a review by the State Personnel Director . You will find the appeals process, the official appeal form, and how ... Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes,… more
- State of Colorado (Denver, CO)
- …appeal with the State Personnel Board or request a review by the State Personnel Director . You will find the appeals process, the official appeal form, and how ... Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes,… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... 011250 CCA-Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …card distribution, accurate provider directories, performance on VBC contracts, benefit adjudication, appeals , and grievances . + Collaborate with the TPA to ... corrective action plans. FINANCIAL MANAGEMENT: + In conjunction with Sr. Director , Finance, oversee financial performance, manage budget and costs, and identify… more