- Humana (Honolulu, HI)
- …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 (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
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently...such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess). Experience… more
- Martin's Point Health Care (Portland, ME)
- …and resolution of appeals on as needed basis. + Represent the appeals function on corporate initiatives, projects, committees, as needed. + All other ... been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This role… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for...assigning all incoming appeals and grievances… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …clinical teams + Strong background in quality improvement, utilization management, appeals and grievances , and clinical operations + Insurance industry ... role\. It's an opportunity to shape the future of care for Medicare Advantage and Dual Eligible populations, lead multidisciplinary teams, and influence policy,… more
- Molina Healthcare (Hartford, CT)
- …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , and other ... position plans, organizes, staffs, and coordinates the operations of state Medicaid, Medicare and Marketplace Health Plan operations. * Works with staff and senior… more