- Sanford Health (Sioux Falls, SD)
- …related field required. Master's degree preferred. Minimum of 7 years of experience in health plan appeals and grievances , regulatory oversight, or health ... Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an attractive benefits package… more
- Humana (Pierre, SD)
- …The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and… more
- Humana (Pierre, SD)
- …first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- Cognizant (Pierre, SD)
- …and responsibility for assigned accounts. . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well ... delays in payment. . Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in… more
- Highmark Health (Pierre, SD)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... + None **Preferred** + Master's Degree in Business Administration/Management or Public Health **EXPERIENCE** **Required** + 5 years in Clinical, Direct Patient care… more