- Elevance Health (Atlanta, GA)
- …+ Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved ... **Nurse Appeals ** **Hybrid 1:** This role requires associates to...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- CenterWell (Atlanta, GA)
- …of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Atlanta, GA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Atlanta, GA)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on… more
- Humana (Atlanta, GA)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...and care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
- Humana (Atlanta, GA)
- …not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Elevance Health (Atlanta, GA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual**...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Elevance Health (Atlanta, GA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Carelon Medical Benefit Management** **Radiology Benefit Management** Surgery (Including: General, Dermatology,… more