- Point32Health (Canton, MA)
- …. **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight ... of the Enterprise Member Appeals and Grievances Department. The Director is...for; directing, leading, and modifying the business processes and operations for member appeals and member grievances… more
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- CVS Health (New York, NY)
- …decision support tools that provide actionable insights into organizational operations . + Confers with executives, clinicians, researchers, and administrators, to ... and AI, to generate measurable business impact. + Experience in Healthcare operations (payer and/or provider) Preferred Qualifications + Master's Degree or PhD… more
- Universal Health Services (Reno, NV)
- …at: https://prominence-health.com/ Job Summary: Under the direction of the Manager of Operations , the Appeals Specialist is responsible for ensuring the ... review, research, processing and responding to written member and provider complaints, appeals , and grievances. This position is required to apply analytical and… more
- Pacific Medical Centers (Seattle, WA)
- **Description** **Overview:** The director provides leadership for USFHP clinical operations : including care management and the clinical quality management ... program. In collaboration with the Executive Director , develops and implements policies and procedures, staff training materials, and process protocols. Oversight… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Public Service Manager 2 - Director of Operations Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4504305) Public Service Manager 2 - ... Director of Operations Salary $93,288.00 - $132,828.80...Full-time Job Number 24-03862 Agency 429 Department of Inspections, Appeals & Licensing - Racing & Gaming Commission Opening… more
- CVS Health (Springfield, IL)
- …and can be located anywhere in the United States.In this role as Medical Director MPO (Medical Policy & Operations ) you will be responsible for providing ... Health company has an outstanding opportunity for a Medical Director . Ready to take your career to the next...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus on ... pre-service and post-service utilization review, clinical claims audit, clinical appeals and reconsiderations, medical policy, and program management. Responsible… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Public Service Manager 1 - Director of Gaming Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4507757) Public Service Manager 1 - Director of ... Full-time Job Number 24-03893 Agency 429 Department of Inspections, Appeals & Licensing - Racing & Gaming Commission Opening...Please send cover letter and resume to Betty Tschetter, Director of Licensing and Administration at ###@iowa.gov by May… more
- Johns Hopkins University (Baltimore, MD)
- Reporting to the Peabody Executive Director of Enrollment Management, we are seeking a **_Director of Financial Aid_** who will supervise the daily operations of ... students and their families throughout the financial aid application process. The Director is responsible for determining a student's eligibility for aid, following… more
- University of Rochester (Rochester, NY)
- …and leaders in the College Center for Advising Services, the Assistant Director develops, executes, and assesses plans that improve current academic advising ... meeting institutional goals for student retention and timely graduation. The Assistant Director provides guidance and training to other academic advisors within the… more
- Montana State University (Bozeman, MT)
- …goals, is responsible for large donor cultivation, and directs or supports campaigns and appeals . The Director is a critical member of the museum's leadership ... please contact: Chris Dobbs, ###@montana.edu, ### Classification Title Managing Director Working Title Director of Development and...donor base. + Develop and implement annual and special appeals as needed, and under the leadership of the… more
- State of Massachusetts (Boston, MA)
- …Peace Officer Standards and Training Commission Job Posting/* * * *Job Title: Deputy Director of Police Standards * *Reports to: Director of Police Standards* ** ... team of the Division of Police Standards ("Division") as its Deputy Director . The Division advances the Commission's statutory mission of investigating allegations… more
- Pennsylvania State University (University Park, PA)
- …frontline fundraiser with strong written communication skills in the role of Assistant Director of Arts Advancement to engage alumni and friends as partners in ... and contribute to one of the most successful fundraising and alumni relations operations in the country. The University is committed to ensuring that diversity,… more
- Centene Corporation (Jefferson City, MO)
- …implement, and lead a system of controls to assess. Monitors operations , risk management processes, evaluates, and operationalizes strategies, and leads ... implementation of compliance/business initiatives. Executes operations to foster an ethical leadership culture, demonstrates adherence to federal/state regulatory… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …segmentation, prospect research and relationship management. + Work closely with Development Operations Manager, Director of Major Gifts and Chief Development ... Officer and in partnership with the Development Team, the Director of the Annual Fund will play a key...support from individuals through various annual fund vehicles (ie, appeals , fundraising events, monthly giving, donor tours, stewardship), 2)… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Director Quality Management/Compliance Officer 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #11961 Monday, May 13, 2024 Director of Quality and Compliance ... (https://cottonwoodcanyonhc.com/ director -staff-development/) The Director of Quality and Compliance strives to ensure that all Agency personnel adhere to… more
- Highmark Health (Charleston, WV)
- …are by nature both line and staff functions. The incumbent assists operations /programs to comply with accreditation and regulatory standards, including but not ... providers across the network. + Attend meetings as appropriate, including medical director meetings, QI committee and subcommittees, as assigned. + Contribute to the… more
- Elevance Health (Denver, CO)
- …Board Certified Child & Adolescent Psychiatrist who will be responsible for appeals reviews within our Medicaid and Medicare programs.** The **Behavioral Health ... Medical Director ** is responsible for the administration of behavioral health...consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care opportunities. May serve… more