- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- Sanford Health (Sioux Falls, SD)
- …and grievances processing. Collaborate with legal, compliance, operations, and medical management teams to address complex cases and ensure proper resolution. ... complaints, and grievance processes across all product lines, including ACA, Commercial, Medicare Advantage, Medicaid, DSNP, and ISNP. This role ensures adherence to… more
- Sanford Health (Sioux Falls, SD)
- …Shifts **Job Schedule:** Full time **Weekly Hours:** 40.00 **Job Summary** The Director of Provider Network Contracting is responsible for maintaining and growing a ... resources to ensure compliance with applicable state/federal access requirements. The Director will negotiate reimbursement terms that are built on Sanford Health… more