- CareFirst (Baltimore, MD)
- …of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines ... for Care Management. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Elevance Health (Hanover, MD)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... onboarding and skill development. Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more
- CenterWell (Annapolis, MD)
- …to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...+ Oversee the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit… more
- CenterWell (Annapolis, MD)
- …revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore ... onshore and offshore teams. * Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams. ** Clinical...Teams * Revenue Cycle Leadership * Billing, Denials, and Appeals Teams * Compliance, Legal, and Audit * IT… more
- Elevance Health (Hanover, MD)
- …Alternate locations can be considered. Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting ... This role involves managing the overall medical policies and clinical guidelines to ensure appropriate and cost-effective care. The...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Elevance Health (Hanover, MD)
- …onboarding and skill development. Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting ... responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Elevance Health (Hanover, MD)
- ** Clinical Operations Associate Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/Utilization Review** **Virtual:** This role ... onboarding and skill development. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more