- Humana (Boston, MA)
- … 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
- Fallon Health (Worcester, MA)
- **Overview** **The Member Appeals and Grievances Intake Administrator is working M - F 8 am to 5 pm in the office 5 days/week. We are looking for someone that is ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and… more
- University of Massachusetts Amherst (Amherst, MA)
- Director of Human Resources (Facilities & Campus Services) (Hybrid Opportunity) Apply now ... adds to the intellectual energy of the region. Job Summary As the Director of Human Resources Facilities & Campus Services (F&CS) Service Center, manages effective… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... Twitter and LinkedIn. **Brief summary of purpose:** With general direction from the Director of Quality, the Program Manager, Accreditation & Audit ensures that the… more
- Beth Israel Lahey Health (Westwood, MA)
- …address information. Escalates calls to pharmacists for clinical inquiries and escalates grievances to supervisor. 7. Maintains new and existing patient profiles and ... Support health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing problems/issues with… more