- Humana (Sacramento, CA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CenterWell (Sacramento, CA)
- …compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, via phone ... caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal...required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to… more
- Molina Healthcare (Sacramento, CA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- CenterWell (Sacramento, CA)
- …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more