- Humana (Little Rock, AR)
- …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… more
- Molina Healthcare (Green Bay, WI)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and… 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
- Humana (Juneau, AK)
- … (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… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Prepares recommendations to either uphold or deny appeal and forwards to Medical Director as needed. + Ensures that appeals and grievances are resolved ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical...None **Essential Duties and Responsibilities:** + Extrapolates and summarizes medical information for medical director ,… more
- Elevance Health (Mason, OH)
- …Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as needed. + Ensures that ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular… more
- Molina Healthcare (Dayton, OH)
- …actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Sharp HealthCare (San Diego, CA)
- …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours**...+ Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care… more
- Independent Health (Buffalo, NY)
- …for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing health ... Medical Director . This position will prepare written responses to appeals and complaints/ grievances , establish plans of correction and provide education… more
- Centene Corporation (Olympia, WA)
- …Conducts concurrent and retrospective reviews of claims and appeals , and resolves grievances related to medical quality of care. + Leads, develops, directs ... a fresh perspective on workplace flexibility. **Position Purpose:** The Behavioral Health Medical Director provides clinical leadership and support of the Chief… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... physical and mental well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality, is responsible for… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care… more
- Fallon Health (Worcester, MA)
- …is responsible for the presentation of the member appeal to the FH Medical Director , Center for Medicare/Medicaid Services, contracted reviewer, as well as ... staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures… more
- City of St. Charles (St. Charles, MO)
- …MO, USA | Salary | 123,392.60-148,071.11 per year | Full Time | Medical , Dental, Voluntary Vision, Life and Disability Insurance; FSA; HSA; Lagers Pension- L6 ... Employee Assistance Programs and Educational Benefits. Job Title Assistant Public Works Director Department Public Works Posting Date June 11, 2025 Closing Date for… more
- Highmark Health (Salem, OR)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- State of Colorado (Pueblo, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... 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)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... I-IV qualify as "Safety Officers" and are eligible for increased PERA benefits. + Medical and dental health plans + Short and long term disability coverage + Paid… more
- Skookum Contract Services (Colorado Springs, CO)
- …same. + Investigate, prepare documentation, and recommend Tessera's position on grievances , complaints, and appeals . Responds to employee relation issues ... such as employee complaints, harassment allegations, and grievances . Work with employees, employee representatives, Supervisors, Managers, and legal counsel to… more
Related Job Searches:
Appeals,
Appeals Grievances,
Director,
Director Appeals Grievances,
Grievances,
Medical,
Medical Director