• Registered Nurse - Clinical Appeals…

    Cognizant (Washington, DC)
    …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work… more
    Cognizant (10/09/25)
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  • Part-Time Weekend Medical Director…

    Highmark Health (Washington, DC)
    …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
    Highmark Health (09/11/25)
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  • Director of Operations

    AmeriHealth Caritas (Washington, DC)
    …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , Network adequacy and ... **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the.... **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time… more
    AmeriHealth Caritas (10/28/25)
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  • Performance Sustainability Manager

    AmeriHealth Caritas (Washington, DC)
    …Performance Sustainability Manager (Healthy DC Plan) will report directly to the Director Operations and will drive product performance across key functional areas ... requirements, including call center SLAs, member and provider grievance & appeals , claims timeliness, provider credentialing, UM turnaround times. + Responsible to… more
    AmeriHealth Caritas (10/30/25)
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