- CVS Health (Hartford, CT)
- …remote based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part ... AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly… more
- AmeriHealth Caritas (Newark, DE)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... experience in a Managed Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will have:** + Proven experience… more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory ... (15%) Maintain the monthly reporting responsibilities, Appeals and Grievance reporting to Department Director , ongoing referrals and authorizations… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... This position will work with department Supervisors, Managers and Director for all problems related to quality improvements as...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
- Elevance Health (Tampa, FL)
- …+ Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved ... **Nurse Appeals ** **Hybrid 1:** This role requires associates to...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Humana (St. Paul, MN)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....member population, or condition type. May also engage in grievance and appeals reviews. May participate on… 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
- City of New York (New York, NY)
- …planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy ... arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance ...process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp Health Plan's (SHP) ... 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - Medical...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical coverage review, member… more
- Sharp HealthCare (San Diego, CA)
- …physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical Board of CA ... from summary data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains benchmarked utilization… more
- Humana (Baton Rouge, LA)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- DEPUTY DIRECTOR OF ELIGIBILITY (MEDICAID DEPUTY DIRECTOR ) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5062744) Apply DEPUTY ... DIRECTOR OF ELIGIBILITY (MEDICAID DEPUTY DIRECTOR ) Salary $7,540.00 - $14,792.00 Monthly Location Baton Rouge, LA Job Type Classified Job Number MVA/PJ/212444… more
- Humana (Raleigh, NC)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Oregon State University (Corvallis, OR)
- …for responding to the concerns of disabled students per the DAS grievance / appeals procedures. + Mediates disability-related academic issues between faculty and ... & Compl Job Title Assistant Dean of Students and Director of Disability Access Services Appointment Type Professional Faculty...Services is seeking an Assistant Dean of Students and Director of Disability Access Services. This is a full-time… more
- Elevance Health (Atlanta, GA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management** **Radiology Benefit Management/Utilization Review** _A proud member of the… 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 fully ... between 8am - 4pm EST, in order to attend grievance hearings. One of the perks of this position...weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality,...Commercial, Medicaid, Medicare, and Special Need Plans (SNPs). The Director , Quality will work closely with Sr. Manager, Audit… more
- Transdev (North Las Vegas, NV)
- …The Labor Relations Manager provides support to the Area General Manager, Director of Human Resources, and Operations Teams on labor relations projects, priorities ... ensure consistency in language and interpretation of collective bargaining agreements, grievance management, and arbitration preparation. Transdev is proud to offer:… more