- Humana (Little Rock, AR)
- …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 (Juneau, AK)
- …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
- Trinity Health (Columbus, OH)
- … and Grievance Coordinator is responsible for the processing and resolution of appeals , grievances and disputes from members and providers **What You Will ... preparation of case files and review with clinical colleagues. + Screen all incoming grievances , appeals and provider claim dispute to ensure they are within… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Development Specialist III Job Category: Administrative, HR, Business Professionals Department: CSC ... Appeals & Grievances Location: Los Angeles, CA,...design and training facilitation. Experience in Managed Care, Medicaid, Medicare experience. Experience working in an Agile or fast-paced… more
- Commonwealth Care Alliance (Boston, MA)
- …5+ years of clinical nursing experience is strongly preferred. + Experience in Medicaid/ Medicare grievances and appeals and/or Utilization Review is strongly ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate...compliance with state and federal guidelines, including Centers for Medicare and Medicaid Services requirements. Maintain all appeals… more
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …on the Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) ... care system. + Develops, conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as… more
- Elevance Health (Indianapolis, IN)
- …Vendors (Vision, Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with ... issue management for multiple states and for Medicaid and Medicare lines of business. **How You Will Make an...partners. + Monitors vendor performance to ensure compliance with corporate , state, federal and regulatory requirements. + Develops and… more
- Point32Health (Canton, MA)
- …including but not limited to P&T, DCC, MAD, Management team meetings, Appeals & Grievances , Quality Performance Improvement Team (QPIT). + Direct ... to meet regulatory and accreditation requirements and to meet Point32Health's corporate priorities. The Senior Clinical Pharmacist also oversees the structure and… more